Ask the Sports Doc: Pinky toe problem

Published 9:34 pm Friday, March 4, 2011

By Manish Patel

Dear Dr. Patel,

My son is a very athletic 17-year-old and recently was diagnosed with a Jones fracture of the foot. We were advised to have a screw placed in the foot instead of having a cast placed. Do you think surgery may be warranted?

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Patel writes: A Jones fracture is when the fifth bone (pinky) in the foot fractures near the base of the bone.

This fracture has a high risk of not healing. The blood supply to this area of the bone is in an area called the watershed region. There are several regions of the body that have poor blood supply to the bone and unfortunately this is one of them.

In order for any fracture to heal you need four main elements: time, immobilization, blood supply and cortical contact (connections of the two broken ends). If one of these elements is not present then the bone may not heal.

For your active son, I would also recommend a screw placement. The screw will allow him to immobilize the two ends and let him continue to play sports at an earlier stage in the fracture healing process. Placing a screw will also increase his chances of healing if he is going to walk on that foot early.

If this same fracture is treated in a cast, I may have my patients remain non-weight bearing for as long as three months because the blood supply to this region is poor.

Even with three months of non-weight bearing or screw placement, there is still a high risk of this bone not healing. Another factor that affects bone healing is smoking. Hope this helps.