The Benefits of Using the Bone Bruise Technique on a Jones Type Fracture in a Foot

Author: Terri Koziell PT

Abstract: This case study will show that utilizing Integrative Manual Therapy, specifically the Bone Bruise technique facilitated rapid healing in Jones type fracture of the foot after six months of conventional treatment yielded unsuccessful results.

Key Words: Bone Bruise, Jones Fracture, Fracture, Foot

Introduction: Sir Robert Jones originally described the term Jones fracture in 1902 as a transverse fracture between the area of insertion of the peroneus brevis and the peroneus tertius tendons on the fifth metatarsal head. The injury normally occurs with a traumatic plantarflexion and adduction force placed to the forefoot. It is not uncommon with abnormal biomechanical stresses through the foot and ankle to stress the junction of the metaphysis and diaphysis of the fifth metatarsal causing a stress fracture type injury. Because of the anatomical structure of the fifth metatarsal, it is prone to poor healing. The cortex of the fifth metatarsal bone thickens making a transition from cancellous bone to cortical bone, and the medullary canal narrows at the junction of the proximal metaphysis and diaphysis resulting in poor vascularization.

Optimal treatment is non weight-bearing immobilization for a minimum of four weeks, followed by the use of a walking cast or orthosis for an additional four weeks. Evidence of union may appear in eight to twelve weeks. Prolonged immobilization up to six months is not unheard of. Failure to heal in twelve weeks is not uncommon and conservative treatment often leads to delayed union or nonunion. Jones fractures are best treated with the percutaneous insertion of a cannulated screw placed longitudinally down the intramedullary canal.

Treatment with Integrative Manual Therapy has been shown to produce similar functional outcomes in two to three visits without surgical intervention.

History: In this case, a forty-nine year old female initially complained of an onset of symptoms in June 2000. It was originally diagnosed as plantatfascitis and was treated with a night splint and she received multiple injections with no resolution to her original complaints of lateral foot pain. In September 2000, a bone scan revealed a Jones type fracture of the left foot. She was immobilized non-weight bearing in a cast for four weeks, and a walking cast for an additional four weeks. When she initiated therapy in November 2000, she was weight-bearing as tolerated in a low tied CAM walker.

Evaluation: She reported constant pain fluctuating in intensity 2-7/10 down the left fifth metatarsal region. She presented with functional limitations in standing tolerance, ambulation endurance and sleeping tolerance because of pain. She was unable to squat, jump or stand in a toe-raised position.

Treatment: The patient was treated with Integrative Manual Therapy utilizing the Bone Bruise technique to the fifth metatarsal. The ‘Bone Bruise technique’ was developed by Sharon W. Giammatteo PhD, PT, IMP,C to restore the vertical dimension within the trabecula of bone.

Outcome: Within three treatment sessions, the patient reported, "feeling the best she has in six months". She was full weight bearing, wearing regular shoes, and ambulating without any complaints of pain. She reported improvement in standing tolerance, ambulation endurance, balance and reported sleeping through the night without interruption.

With her subjective complaints dissipated, and function restored, surgery was cancelled.