Kevin Durant’s injury
Reigning NBA most valuable player, Kevin Durant, recently underwent surgery to repair a fracture to the 5th metatarsal bone. On October 13th, 2014, news reports came in of the injury. Speculation of the seriousness of the injury was well founded as demonstrated by the surgery required to repair it. But, what remains from this for me is the confusion in the name of the injury. The ESPN report stated that he had a “’Jones fracture,’ a broken bone at the base of the small toe.”(1) Later, the article referred to it as a stress fracture. Adding to the confusion, during an ESPN telecast an analyst pointed to the image below which shows the head or distal end of the 5th metatarsal. These are separate injuries and it is important to delineate what it really is, even though it doesn’t really change the outcome, “@KDTrey5,” will be out until later November. The HIPPA laws in this country prevent us from seeing the xrays or other information that could truly help us understand what injury he actually has, but I will describe a Jones fracture here
What is a Jones Fracture?
A Jones fracture is a break in the bone at the base or proximal end of the 5th metatarsal. Proximal means closer to the origin or center of the body, in this case, proximal is closer to the heel. The telecast showed a fracture at the distal end, or closer to the toes. This is an acute injury that happens when a force moves the front of the foot in while the ankle joint in plantarflexed, or with the toes pointed down. This type of injury typically happens when one missteps on the outside border of the foot. Since a Jones fracture is an acute injury and the ESPN article described it as a stress fracture, (a repetitive/overuse injury), there is added confusion to the astute reader, because they are different clinical entities.
Why the confusion?Eponyms in medicine can be dangerous things. Some eponyms stand the test of time and are straightforward, whereas others get mixed up with other similar problems. When doctors indiscriminately refer to the Jones fracture to mean a number of different clinical presentations as demonstrated in this case of Kevin Durant. Sad to say, but some specific diagnoses become generalized as those less familiar with specific classifications of injuries clump together everything into one. For this reason, it is not surprising that the ESPN injury analyst pointed to the 5th metatarsal during the telecast and allowed us to think that the circle on the screen represented a Jones fracture (see above).
Prognosis – How long will you be out?
The recommended treatment for an acute non-displaced fracture of the 5th metatarsal base is 6-8 weeks of non-weightbearing immobilization. Surgery may be an option for high-performance athletes (such as an NBA all-star like Kevin Durant) and patients who refuse conservative treatment. With surgery, there is still a period of non-weightbearing as the bone still has to heal with surgical intervention. Full recovery may take longer in order to get back to pre-injury status, at 18 weeks, one can expect this type of recovery.
Anatomy of the 5th Metatarsal base:
As you can see, there are a lot of tendons and ligaments that attach to the foot in this region. The correct name of the fracture type is used depending on the precise location of the fracture line.
History lesson – Why is it called a Jones fracture?
As with many eponyms in medicine, this fracture was first described by the person whose name it bears. Sir Robert Jones described 5 patients with this type of fracture back in 1902, one of those patients was himself, so you could say that this is Jones’ fracture, not just a Jones fracture. It is reported that he injured himself while dancing.
1. Lawrence, SJ and Botte, MJ. Jones’ fractures and related fractures of the proximal fifth metatarsal. Foot Ankle International. 1993 (14):358.
1. http://www.tendonitisexpert.com/tendonitis-from-a-5th-metatarsal-head-fracture.html (location of pain)
2. www.aafp.org (anatomy of the 5th metatarsal)