Abstract
Jones fractures are among the most common fractures of the foot; however, much remains
unknown about their etiology. The purpose of the present study was to further examine
the risk factors of forefoot and hindfoot alignment on Jones fractures using an epidemiologic
study design. We used a retrospective, matched, case-control study design. Cases consisted
of patients with acute, isolated Jones fractures confirmed on plain film radiographs
seen at our institute from January 2009 to December 2013. Patients presenting with
pain unrelated to metatarsal fractures served as controls. Controls were matched to
cases by age (±2 years), gender, and year of presentation. Weightbearing foot radiographs
were assessed for 13 angular relationships by a single rater. Conditional multivariable
logistic regression was used to identify important risk factors. Fifty patients with
acute Jones fractures and 200 controls were included. The only significant variables
in the final multivariable model were the metatarsus adductus angle (odds ratio [OR]
1.16, 95% confidence interval [CI] 1.08 to 1.25) and fourth/fifth intermetatarsal
angle (OR 0.69, 95% CI 0.57 to 0.83)—both measures of static forefoot adduction. The
presence of metatarsus adductus (defined as >15°) on foot radiographs was associated
with a 2.4 times greater risk of a Jones fracture (adjusted OR 2.4, 95% CI 1.2 to
4.8). We have concluded that the risk of Jones fracture increases with an adducted
forefoot posture. In our population, which consisted primarily of patients presenting
after a fall (10 of 50; 20%) or misstep/inversion injury (19 of 50; 38%), the hindfoot
alignment appeared to be a less important factor.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: May 31, 2017
Footnotes
Financial Disclosure: This study was partially funded by the National Institute of Diabetes and Digestive and Kidney Diseases (grant 1T35DK074390), which had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Conflict of Interest: Dr. Weil has a leadership position with the journal, Foot and Ankle Specialist; consultant/advisory roles with Arthrex and Medline; ownership in Treace Medical; and has received honoraria from Novastep.
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