Jones Fracture: Is It Safe to Avoid Casting After a Week?

Fifth metatarsal fracture without casting condition?

Hello Dr.
Chen: This is my X-ray: https://imgur.com/1EXNaiQ https://imgur.com/PVTO5Yr.
I twisted my ankle while walking and it has been seven days.
Initially, the orthopedic doctor diagnosed me with a Jones fracture and recommended a cast, but mentioned that some people choose not to wear a cast due to inconvenience at home and work.
I later consulted a traditional Chinese medicine practitioner, and currently, the swelling and pain are less than on the first day.
Dr.
Chen, is it acceptable not to wear a cast? Do I need to use any protective gear? How many months later should I get another X-ray? Thank you, Dr.
Chen.

Chen, 30~39 year old female. Ask Date: 2019/10/24

Dr. Chen Yongxue reply Orthopedics

Hello, the key point is to avoid putting weight on the affected limb and to refrain from unnecessary movement.
A Jones fracture has tendon attachments, and if the ankle is active, it can pull the fracture site apart.
If you decide not to use a cast, please do not bear weight (use crutches for mobility), and do not move the ankle.
The toes can be supported with some splints, which won't be as hot and uncomfortable as a cast, but crutches are still necessary.
Wishing you a speedy recovery.

Reply Date: 2019/10/24

More Info

Jones fracture, which refers to a fracture of the fifth metatarsal bone, is a common injury that can occur due to a variety of reasons, including twisting or rolling the ankle. The management of this type of fracture can vary significantly based on the severity of the fracture, the degree of displacement, and the patient's overall health and activity level.

In your case, it has been seven days since your injury, and you have been advised by an orthopedic doctor to consider casting. While some patients may choose to avoid casting due to lifestyle constraints, it is essential to understand the implications of this decision. Casting is typically recommended for Jones fractures because it helps immobilize the bone and allows for proper healing. The fifth metatarsal is particularly susceptible to nonunion or delayed healing, especially in the Jones area, which is located at the base of the bone.

If you have opted not to wear a cast and have instead sought alternative treatments, such as traditional Chinese medicine, it is crucial to monitor your symptoms closely. The fact that you are experiencing less swelling and pain is a positive sign, but it does not necessarily indicate that the fracture is healing adequately. In the absence of a cast, you may be at a higher risk for complications, including improper healing or even the development of chronic pain.

Regarding your question about whether you need to wear any protective gear, it is advisable to consider using a walking boot or a stiff-soled shoe to provide some level of support to the injured area. This can help reduce the risk of further injury while allowing you to maintain some mobility. However, you should avoid putting full weight on the injured foot until you have received further evaluation from a healthcare professional.

As for follow-up imaging, it is generally recommended to have an X-ray taken about 4 to 6 weeks after the injury to assess the healing progress. This timeframe allows for a clearer view of whether the fracture is healing properly or if further intervention is needed. If you notice any increase in pain, swelling, or difficulty in mobility, it is essential to seek medical attention sooner.

In summary, while some individuals may choose to forgo casting for a Jones fracture, it is generally not advisable due to the risk of complications. If you are experiencing improvement, that is encouraging, but it is essential to remain cautious and consider protective gear. A follow-up X-ray in a few weeks will provide valuable information about your healing process. Always consult with your healthcare provider for personalized advice based on your specific situation.

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