Site‐Specific Loading at the Fifth Metatarsal Base in Rehabilitative Devices: Implications for Jones Fracture Treatment

Hunt, Kenneth J.; Goeb, Yannick; Esparza, Rolando; Malone, Maria; Shultz, Rebecca; Matheson, Gordon O.

doi:10.1016/j.pmrj.2014.05.011

Cited by 25 publications

(13 citation statements)

References 38 publications

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“…Hunt et al 6 studied contact and peak pressures at the base of the fifth metatarsal in 3 different footwear devices: walker boot, HSS, and running shoes. They concluded that there was a significantly less contact and peak pressure in the walker boot compared with the HSS.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Zone 1 Fractures of the Proximal Fifth Metatarsal With CAM-Walker Boot vs Hard-Soled Shoes

et al. 2020

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Background: Zone 1 fractures of the proximal fifth metatarsal are usually treated nonsurgically using some type of immobilization. The aim of this study was to compare clinical and functional outcomes, time to return to prior activity levels, and rate of bone healing when using a hard-soled shoe (HSS) vs a controlled ankle motion (CAM)–walker boot (CWB). Methods: Seventy-two consecutive patients with zone 1 fractures of the fifth metatarsal base were treated conservatively with either an HSS or CWB by 2 different providers. We included 57 women and 15 men, average age of 41.3 (range, 16-88) years. Radiographic findings, visual analog scale (VAS) for pain, and American Orthopaedic Ankle & Foot Society (AOFAS) midfoot score were assessed. Patients were followed at 4, 8, 10, 12, and 24 weeks or until asymptomatic and able to return to prior level of activities. Statistical analysis was performed using Mann-Whitney U, Fisher exact, and chi-square tests. P values <.05 were considered significant. Results: Age and gender distributions were similar in both groups ( P = .23 and P = .57). Patients had similar VAS and AOFAS scores after 8 ( P = .34 and P = .83) and 12 ( P = .87 and P = .79) weeks. Average time for bone healing was significantly faster using the CWB (7.2 weeks) when compared to the HSS (8.6 weeks) ( P < .001). The average time to return to prior level of activities was similar in both groups (8.3 weeks for CWB and 9.7 weeks for HSS) ( P = .11). Fracture displacement was equal in both groups, with a mean of 1.9 mm of displacement in patients using the HSS, and a mean of 1.6 mm in those using the CWB ( P = .26). Conclusion: Zone 1 fractures of the proximal fifth metatarsal can be treated conservatively with either a hard-soled shoe or a CAM-walker boot. Even though patients treated in the CAM-walker boot demonstrated earlier signs of complete healing, similar clinical and functional results were achieved with both treatments. Level of Evidence: Level III, retrospective comparative series.

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Section: Discussionmentioning

confidence: 99%

Treatment of Zone 1 Fractures of the Proximal Fifth Metatarsal With CAM-Walker Boot vs Hard-Soled Shoes

et al. 2020

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“…Esta bota reduce significativamente la presión en la base del quinto metatarsiano en la ambulación, en comparación con un zapato postoperatorio 42 . A las seis/ocho semanas, el paciente podrá apoyar por completo el pie y podrá reanudar su actividad normal 20,40,41 .…”

Section: Rehabilitación Postoperatoriaunclassified

Fractura de Jones, ¿Tratamiento quirúrgico o tratamiento conservador?

López

2018

Rev. Int. Cienc. Podol.

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Resumen. La fractura de Jones se define como una fractura transversal localizada en la unión de la diáfisis con la metáfisis proximal en el quinto metatarsiano y es una de las lesiones más comunes que aparecen en el pie. Es una zona pobremente vascularizada, lo que conlleva altas tasas de no unión de la fractura. Se diagnostica con un exploración clínica, asociada a pruebas radiológicas, siendo necesarias tres proyecciones: lateral, antero-posterior y una oblicua de 45º. Hay distintas clasificaciones como son la de Torg et al. y Dameron et al., que nos ayudan a establecer un tratamiento, en función de la localización de la fractura y su evolución radiológica. El objetivo de este trabajo es realizar una revisión en la literatura científica para valorar las diferencias en los resultados entre el tratamiento quirúrgico y tratamiento conservador, en relación al tiempo de unión ósea y las posibles complicaciones, determinando así cual es el tratamiento óptimo para estas fracturas. Se llega a la conclusión de que el tratamiento conservador es una opción viable, pero conlleva mayores tasas de no unión y mayor tiempo de retorno a la actividad física que el tratamiento quirúrgico, aunque este puede llevar a una serie de complicaciones tales como la lesión del nervio sural o una posible fractura iatrogénica del metatarsiano. El tratamiento quirúrgico, que consiste mediante la fijación con un tornillo intramedular, tiene menor tiempo de reincorporación a la actividad habitual y mayores tasas de consolidación ósea por lo que será de primera elección en deportistas. Palabras clave: fractura de jones; tratamiento quirúrgico; tratamiento conservador.[en] Jones Fracture. Surgical treatment or conservative treatment?Abstract. Jones' fracture is defined as a transverse fracture located at the junction of the diaphysis with the proximal metaphysis in the fifth metatarsal and is one of the most common lesions that appear in the foot. It's a poorly vascularized area, which leads to high rates of non-union of the fractures. It is diagnosed with a clinical examination, associated with radiological tests, three projections are necessary: lateral, antero-posterior and an oblique of 45º. There are different classifications such as Torg et al. and Dameron et al., which help us to establish a treatment, depending on the location of the fracture and its radiological evolution. The objective of this study is to perform a review in the scientific literature to evaluate the differences in the results between surgical treatment and conservative treatment, in relation to the time of union and the possible complications, thus determining which is the optimal treatment for these fractures. We conclude that conservative treatment is a viable option, but it leads to higher rates of non-union and greater time to return to physical activity than surgical treatment, although this may lead to a series of complications such as injury Sural nerve or a possible iatrogenic fracture of the metatarsal. The surgical treatment, which consists of the fixation wi...

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“…The splint is removed after 1 week but patients should remain non-weight bearing for 2 weeks postoperatively and then transition to full weight bearing in a short walker boot. These CAM walker boots significantly reduce contact pressure at the fifth metatarsal base with ambulation compared to postoperative shoe and running shoes [17]. Athletes can advance to running shoes by 4-6 weeks.…”

Section: Treatmentmentioning

confidence: 99%