Further X-rays

If it is important to confirm the diagnosis quickly, MRI or a bone scan should be used. However, as the management of a probable stress fracture of a second MT is unlikely to be changed by confirmation of the fracture, further x-rays after 10-14 days will usually be done and this will reveal a periosteal reaction (Fig 1).

Fig 2 shows a Jones fracture. This must be differentiated from the more common, avulsion fracture at the base of the MT (Fig 3).

In Jones fractures, there is a risk of non-union and so patients should be treated in a below knee POP and referred to an orthopaedic surgeon or sports injuries clinic.

Patients with stress fractures of the 2nd MT need to rest from running and similar exercise. They can continue with cycling and other non-impact sport but will need advice on a graded return to sport.

Click on the images to enlarge.