The “Pseudo-Jones” fracture at or proximal to the styloid process is more common (over 90%) and typically more benign. It is usually caused by sudden inversion of a plantar flexed foot with avulsion of the lateral band of the plantar aponeurosis from the metatarsal. It often present as a twisting injury similar to an ankle sprain.
The “Jones” diaphyseal fracture is less common and potentially more severe. It usually occurs when a load is applied to the lateral forefoot in the absence of inversion in running and jumping activities and pivot-shifting in football, basketball, or soccer with the heel off the ground.
Pain is often diffuse but can be localized on exam since the lateral tuberosity is easily palpable. The fifth metatarsal should be carefully examined in any twisting ankle injury so a fracture at the base of the 5th metatarsal is not mistaken for an ankle sprain.
