Can a bone scan help you tell the difference between a Jones fracture stress reaction and a styloid stress reaction in a runner? Well, good question and that is what we’re talking about today on the Doc On The Run Podcast.
In this episode, what we are going to talk about is a thing called a Jones fracture, and a Jones fracture is a scary fracture if you are a runner. I know because I had one when I was in med school, and we’ll talk about what the Jones fracture is.
If you have been diagnosed with a Jones fracture, you are probably somebody who already understands where it is and how it happens, but this is the short story. So, on the fifth metatarsal bone on the outside of your foot, it is shaped like that. The fourth metatarsal bone sits right next to it like that. Cuboid bone sits back here. That is the front of your heel bone over there and then you have what we call the metaphyseal-diaphyseal junction.
If we look at this on a bigger scale, with this being your styloid process of your fifth metatarsal, this is the shaft of the bone. That is the head of the bone. Well, basically, if you think about it, the shaft is from here to here. That is the head of the bone. That is the shaft of the bone. That is the base.
The base is called the styloid process, and this is the fifth metatarsal that we’re talking about. So, you have the head of the bone, you have the shaft, and the medical term for the shaft is the diaphysis. So, this is cortical bone. It’s diaphyseal bone. This is the base of the bone. It is metaphyseal bone. And so, when you have diaphyseal bone up here, metaphyseal bone down here, this part right here where you get a Jones fracture, and this region is what we call the, it’s very important, it is called the metaphyseal diaphyseal junction. It’s where those two things come together.
Why does that matter? Well, when you get a Jones fracture, first of all, it’s very high risk. There was a study many years ago that showed that if you had a Jones fracture, the treatment was a non-weight-bearing cast for eight weeks, two months. So, crutches and a cast for two months, and about 50% of the people that went through that treatment didn’t actually heal in two months. So, then after two months of being on crutches, when it didn’t heal, they would take them to the operating room and put a screw in the metatarsal to hold it in place so that it would start to heal.
Then you are on crutches again, and now you’ve had two months of off of running. You are just starting surgery. Now you have to recover from surgery, and you are going to lose all your running fitness. You don’t want that, right? You also do not want to ignore this thinking it’s something simple that is just a stress reaction where you’ve been compensating and putting stress on the base of the bone. Totally different. Totally different recovery time. So, the question is, how can a bone scan help you tell the difference?
Well, here’s the thing. The reason that you have poor blood flow here, and the reason a Jones fracture is so difficult to heal, is that you have blood supply coming in from this end that goes in kind of like this. So, there’s all this blood flow in here, and if we injected you full of dye and then look where the blood flow, you would see this pattern where you have lots of blood flow in here, and then you also have nutrient artery comes in, and you get blood flow in here.
There’s blood flow all through the bone up in here. Lots of blood flow in there. But you have this little dead spot right at the metaphyseal-diaphyseal junction where you get a Jones fracture that does not really have any blood flow. And that is also basically an area that separates two separate growth centers between the bone. So, when you are a kid, this piece of bone is ossifying or turning into a solid piece at a different pace than this. And so, this little dead spot here is where there’s not much blood flow.
A bone scan works based on blood flow. So, if you get a bone scan and you have a metatarsal base stress reaction, for example, where the shaft of the bone turns into the base of the bone. If you have been walking compensating, you’ve been walking on the outside of your foot because you had sesamoiditis or some other issue on the inside of your foot, and you stressed it and you aggravated it, and you get a bone scan, the uptake in the bone is all going to be in here.
You are going to have this part lighting up dark and showing up on your bone scan as increased uptake or increased blood flow just in the base of the bone. Now, if you have a bone scan and the bone scan does not really show uptake just to the base of the bone, but it shows it more in this area where you have a Jones fracture, that is bad.
This one is a stress fracture in the styloid process or the base. This one would be a Jones. So yes, in short, if you get enough resolution in the images on your bone scan that actually show you it’s really localized where you had this increased uptake in only the base of the bone and it doesn’t get it all into the shaft or the cortex or the bone, the diaphyseal bone, then yes, it’s probably just a stress reaction in the base of the bone, maybe from the peroneus brevis pulling on it or you walking on the outside of your foot.
But if you have this, where the bone is has all the uptake in that area where you get a Jones fracture where you don’t normally have good blood flow, it’s a very bad sign. So hopefully this helps you understand a little bit more about how a bone scan can tell the difference between a Jones fracture, like a stress fracture in a runner that is going to be really difficult to heal, or if it’s just a stress reaction in the base of the bone and it’s not really a Jones fracture at all.
Hopefully the anatomy of this helps you understand that a little bit better understanding how the bone scan uptake happens and how you can tell the difference between those two important conditions so you can decide how quickly you are going to get back to running.
If you want to learn more about stress fractures in runners and the strategies I use when you have one of these kind of things and you want to keep maintaining your running fitness and want to get back to running sooner, all those strategies are available for you in the Stress Fracture Masterclass. You can get it for free at www.docontherun.com/stressfracturemasterclass. So come sign up and I’ll see you in the training.
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