Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.
Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle
Last reviewed: April 4, 2026
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A Jones fracture is a break at the base of the fifth metatarsal with poor blood supply, leading to high non-union rates (25-30%) with casting alone. Intramedullary screw fixation surgery allows faster return to activity (6-8 weeks vs 12+ for casting) and is preferred for athletes and active patients.
What Is a Jones Fracture?
A Jones fracture is a fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal — the bone on the outer edge of the foot — in a specific zone approximately 1.5 to 2 centimeters from the tip of the fifth metatarsal base. This zone has notoriously poor blood supply and a high rate of delayed healing, non-union, and refracture that distinguishes Jones fractures from other fifth metatarsal fractures. The injury is named for Sir Robert Jones, who described the fracture in 1902 — based on his own injury sustained while dancing.
At Balance Foot & Ankle, our Michigan foot surgeons provide both conservative management for select patients and surgical fixation for athletes and those requiring reliable, timely healing throughout Southeast Michigan.
Why Jones Fractures Are Different From Other Fifth Metatarsal Fractures
The fifth metatarsal is commonly fractured, but location matters enormously for prognosis and treatment. Avulsion fractures at the very tip of the fifth metatarsal base — Zone 1 — occur from ankle inversion injury pulling the peroneus brevis tendon and are generally treated conservatively with good outcomes. Jones fractures — Zone 2 — occur in a watershed area of blood supply where the proximal nutrient artery and the diaphyseal arterial supply meet without significant anastomosis, creating a zone that heals slowly and unreliably with non-surgical treatment. Zone 3 diaphyseal stress fractures carry similar healing challenges.
Who Needs Surgery?
Surgical fixation is strongly recommended for athletes wishing to return to sport, active individuals who cannot tolerate 6 to 10 weeks of non-weight bearing, patients with delayed union or refracture, and anyone with Zone 3 stress fracture. Non-surgical treatment with non-weight bearing cast immobilization for 6 to 8 weeks is an option for low-demand patients willing to accept the higher rate of delayed union and the possibility of requiring surgery if conservative management fails. The evidence strongly favors surgical fixation for competitive athletes given the faster and more reliable return to sport.
The Intramedullary Screw Technique
The standard surgical treatment is intramedullary screw fixation. A small incision is made at the base of the fifth metatarsal. Under fluoroscopic guidance, a guidewire is inserted into the medullary canal of the fifth metatarsal and advanced across the fracture site to the distal metatarsal. The canal is then drilled and a solid or cannulated titanium or stainless steel screw is inserted to compress the fracture fragments and provide stable fixation. Screw diameter selection is important — undersized screws have higher refracture rates, and surgeons typically use the largest diameter screw that the medullary canal accommodates.
Recovery After Jones Fracture Surgery
Protected weight bearing in a CAM boot for 4 to 6 weeks is typical following intramedullary screw fixation. Progressive return to activity begins with low-impact walking, then jogging, then cutting and jumping activities as X-ray evidence of healing confirms fracture consolidation. Most athletes return to sport at 8 to 12 weeks post-surgery — substantially faster than the 12 to 20 weeks typically required with conservative management. Refracture is significantly reduced compared to non-operative treatment.
If you have outer foot pain after a twisting injury or suspect a Jones fracture, contact Balance Foot & Ankle for evaluation. Our foot surgeons provide Jones fracture care throughout Southeast Michigan with same-week appointments.
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Warning
Jones fractures have a 25-30% non-union rate with casting alone due to poor blood supply at the fracture site. Delayed diagnosis or inadequate treatment can lead to chronic fracture, re-fracture, and need for complex revision surgery.
Frequently Asked Questions
How long is recovery after Jones fracture surgery?
After intramedullary screw fixation, most patients are weight bearing in a boot at 2 weeks, transitioned to shoes at 6-8 weeks, and return to running and sports at 3-4 months. Athletes treated surgically return to full activity roughly twice as fast as those treated with casting.
Can a Jones fracture heal without surgery?
Yes, but 25-30% of Jones fractures fail to heal with casting alone (non-union) due to poor blood supply. Non-athletic, sedentary patients may try 6-8 weeks of non-weight-bearing casting, but athletes and active adults typically benefit from surgical fixation.
What is the difference between Jones fracture and avulsion fracture?
An avulsion fracture is at the very tip of the fifth metatarsal base from ligament pull and heals well with walking boot. A Jones fracture is 1.5-3cm distally at the metaphyseal-diaphyseal junction, has poor blood supply, and often requires surgery.
Fifth Metatarsal Fracture? See a Foot Surgeon
Dr. Biernacki performs intramedullary screw fixation for Jones fractures with proven return-to-activity protocols. Same-week consultations at 7 Michigan locations.
Book AppointmentJones Fracture Treatment at Balance Foot & Ankle
A Jones fracture at the base of the fifth metatarsal is notoriously slow to heal due to poor blood supply in this area. Dr. Tom Biernacki at Balance Foot & Ankle offers both conservative and surgical treatment including intramedullary screw fixation at our Howell and Bloomfield Hills offices.
Learn About Our Fracture Treatment Options | Book Your Appointment | Call (810) 206-1402
Clinical References
- Roche AJ, Calder JDF. “Treatment and return to sport following a Jones fracture of the fifth metatarsal: a systematic review.” Knee Surgery, Sports Traumatology, Arthroscopy. 2013;21(6):1307-1315.
- Mologne TS, et al. “Early screw fixation versus casting in the treatment of acute Jones fractures.” American Journal of Sports Medicine. 2005;33(7):970-975.
- Dean BJ, et al. “The management of Jones fractures.” British Medical Bulletin. 2019;129(1):43-52.
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Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.
Frequently Asked Questions
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- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
- Hallux Valgus (Bunions): Evaluation and Management (PubMed)
- Bunions (Mayo Clinic)
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