Question
A 19 year old basketball player has lateral midfoot pain after landing. He had some pain in the same area for a few weeks before.
- Describe the radiograph and classify proximal fifth metatarsal fractures.
- Why does the Jones zone heal poorly?
- How would you treat him?
Answer
Radiograph
- Transverse fracture of the proximal fifth metatarsal at the metaphyseal diaphyseal junction
- Jones fracture (zone 2)
- Prodromal pain suggests a stress fracture
Zones
| Zone | Location | Mechanism |
|---|---|---|
| 1 | Tuberosity avulsion | Inversion, lateral band of plantar fascia and peroneus brevis |
| 2 | Metaphyseal diaphyseal junction (Jones) | Forefoot adduction |
| 3 | Proximal diaphysis | Stress fracture |
Poor healing
- Watershed area between the nutrient artery and metaphyseal vessels
- High tensile load on the lateral border
- Cavovarus feet add load
Treatment
- Zone 1, walking boot and weight bear as tolerated
- Zone 2 in athletes, intramedullary screw fixation for faster union and return to sport
- Zone 2 in non athletes, non weight bearing cast for 6 to 8 weeks
- Zone 3 and nonunions, intramedullary screw with bone graft
- Correct cavovarus alignment and vitamin D deficiency
Related pages
Author Contributions
Orthofracs team
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.