Advertisement

Forefoot Adduction Is a Risk Factor for Jones Fracture

      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

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Foot and Ankle Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Clapper M.F.
        • O'Brien T.J.
        • Lyons P.M.
        Fractures of the fifth metatarsal: analysis of a fracture registry.
        Clin Orthop Relat Res. 1995; 315: 238-241
        • Yates J.
        • Feeley I.
        • Sasikumar S.
        • Rattan G.
        • Hannigan A.
        • Sheehan E.
        Jones fracture of the fifth metatarsal: is operative intervention justified? A systematic review of the literature and meta-analysis of results.
        Foot (Edinb). 2015; 25: 251-257
        • DeLee J.C.
        • Evans J.P.
        • Julian J.
        Stress fracture of the fifth metatarsal.
        Am J Sports Med. 1983; 11: 349-353
        • Kavanaugh J.H.
        • Brower T.D.
        • Mann R.V.
        The Jones fracture revisited.
        J Bone Joint Surg Am. 1978; 60: 776-782
        • Raikin S.M.
        • Slenker N.
        • Ratigan B.
        The association of a varus hindfoot and fracture of the fifth metatarsal metaphyseal–diaphyseal junction: the Jones fracture.
        Am J Sports Med. 2008; 36: 1367-1372
        • O'Malley M.
        • DeSandis B.
        • Allen A.
        • Levitsky M.
        • O'Malley Q.
        • Williams R.
        Operative treatment of fifth metatarsal Jones fractures (zones II and III) in the NBA.
        Foot Ankle Int. 2016; 37: 488-500
        • Lareau C.R.
        • Hsu A.R.
        • Anderson R.B.
        Return to play in national football league players after operative Jones fracture treatment.
        Foot Ankle Int. 2016; 37: 8-16
        • Lawrence S.J.
        • Botte M.J.
        Jones' fractures and related fractures of the proximal fifth metatarsal.
        Foot Ankle. 1993; 14: 358-365
        • Dawoodi A.I.
        • Perera A.
        Radiological assessment of metatarsus adductus.
        Foot Ankle Surg. 2012; 18: 1-8
        • Fishco W.D.
        • Ellis M.B.
        • Cornwall M.W.
        Influence of a metatarsus adductus foot type on plantar pressures during walking in adults using a pedobarograph.
        J Foot Ankle Surg. 2015; 54: 449-453
        • Yoho R.M.
        • Carrington S.
        • Dix B.
        • Vardaxis V.
        The association of metatarsus adductus to the proximal fifth metatarsal Jones fracture.
        J Foot Ankle Surg. 2012; 51: 739-742
        • Dean B.J.
        • Kothari A.
        • Uppal H.
        • Kankate R.
        The Jones fracture classification, management, outcome, and complications: a systematic review.
        Foot Ankle Spec. 2012; 5: 256-259
        • Stewart I.M.
        Jones's fracture: fracture of base of fifth metatarsal.
        Clin Orthop. 1960; 16: 190-198
        • Bartl R.
        • Frisch B.
        Risk factors for fractures.
        in: Osteoporosis. ed 2. Springer, New York2009
        • Hasselman C.T.
        • Vogt M.T.
        • Stone K.L.
        • Cauley J.A.
        • Conti S.F.
        Foot and ankle fractures in elderly white women: incidence and risk factors.
        J Bone Joint Surg Am. 2003; 85-A: 820-824
        • Meschan I.
        Radiology of the normal foot.
        Semin Roentgenol. 1970; 5: 327-340
        • Thomas J.L.
        • Kunkel M.W.
        • Lopez R.
        • Sparks D.
        Radiographic values of the adult foot in a standardized population.
        J Foot Ankle Surg. 2006; 45: 3-12
        • Dominguez G.
        • Munuera P.V.
        Metatarsus adductus angle in male and female feet: normal values with two measurement techniques.
        J Am Podiatr Med Assoc. 2008; 98: 364-369
        • Yu G.V.
        • DiNapoli D.R.
        surgical management of hallux abducto valgus with concomitant metatarsus adductus.
        in: Reconstructive Surgery of the Foot and Leg. Podiatry Institute Publishing, Tucker, GA1989
        • Rothman K.J.
        • Greenland S.
        Causation and causal inference.
        in: Modern Epidemiology. ed 2. Lippincott-Raven, Philadelphia1998
        • Woodward M.
        Epidemiology: study design and data analysis.
        ed 3. Chapman and Hall/CRC Press, Boca Raton, FL1999
        • Smith J.W.
        • Arnoczky S.P.
        • Hersh A.
        The intraosseous blood supply of the fifth metatarsal: implications for proximal fracture healing.
        Foot Ankle. 1992; 13: 143-152
        • Dameron Jr., T.B.
        Fractures and anatomical variations of the proximal portion of the fifth metatarsal.
        J Bone Joint Surg Am. 1975; 57: 788-792
        • Nunley J.A.
        Fractures of the base of the fifth metatarsal: the Jones fracture.
        Orthop Clin North Am. 2001; 32: 171-180
        • Darabos N.
        • Obrovac K.
        • Knez N.
        • Darabos A.
        • Hudetz D.
        • Elabjer E.
        Combined surgical therapy and orthotic management of stress and tuberosity avulsion fracture of the fifth metatarsal bone: a case report.
        J Am Podiatr Med Assoc. 2009; 99: 529-535
        • Wright R.W.
        • Fischer D.A.
        • Shively R.A.
        • Heidt Jr., R.S.
        • Nuber G.W.
        Refracture of proximal fifth metatarsal (Jones) fracture after intramedullary screw fixation in athletes.
        Am J Sports Med. 2000; 28: 732-736