Treatment of Incomplete Jones Fractures With Low-Intensity Pulsed Ultrasound (LIPUS).

Abstract

Stress fractures of the proximal epiphysis of the fifth metatarsal bone (termed Jones fracture) frequently occur in both senior high-school-age and older contestant-level soccer players, and its incidence in Japanese soccer players is higher than that in European players. Surgery is most commonly indicated for a complete fracture, and about 3 months are required before the patient is able to return to the sport. We have performed a "Jones fracture screening" to reduce the incidence of these fractures. While surveying its frequency and promoting education on its prevalence and symptoms, we tried to discover incomplete fractures early and treat them using LIPUS without limiting their soccer practice. The subjects were 341 students (682 feet) from 3 senior high schools and university soccer clubs. Primary screening for tenderness and by diagnostic ultrasound imaging was performed as a Jones fracture screening. Fifty subjects (50 feet) were positive on the ultrasonic diagnosis, and secondary screening was recommended. Forty subjects underwent radiography (secondary screening rate: 80%), and 5 subjects (5 feet) were diagnosed with incomplete Jones fractures. Conservative treatment centering on LIPUS was performed in these 5 players who still continued to participate in all soccer practices. Bone union was achieved in 2 subjects (2 feet) after about 6 months without taking a break from soccer practice. The other 3 subjects (3 feet) are at 2 months after the diagnosis and are being followed without taking a break from soccer practice. Incomplete Jones fractures that are discovered early by an ultrasonic check-up for bone expansion with subsequent early treatment with LIPUS may heal without taking a break from practice. No preventive method has been established for Jones fractures. This check-up may serve as a useful preventative approach, and we will make an effort to suggest it as a common practice.