Fractures of the proximal fifth metatarsal are relatively common in the military population and they fall into 3 distinct categories: tuberosity avulsion fractures, acute Jones fractures, and diaphyseal stress fractures. Differentiating between these categories is important for appropriate management and often requires x-rays for definitive diagnosis. The case presented here was chosen because it was initially misread and therefore serves as a good example of the diagnostic challenge of this type of fracture.

The most common fracture of the proximal fifth metatarsal is the tuberosity avulsion fracture. This fracture is typically extra-articular and fracture displacement is uncommon. Most fractures of this type can be treated by placing the patient in a hard-soled shoe or walking cast and they typically heal by 8 weeks.

The term "Jones Fracture" refers to a transverse fracture at the junction of the diaphysis and the metaphysis without extension distal to the fourth-fifth intermetatarsal articular facet. If the main fracture line extends into the metatarsocuboid region, it is not a true Jones fracture. The indiscriminate use of the term "Jones fracture" is a cause of much confusion in the literature as well as in day-to-day clinical experience. In fact, the films presented here were initially read as a "Jones Fracture." The recommended treatment of a true nondisplaced Jones fracture is non-weight-bearing ambulation in a short leg cast for 6 to 8 weeks. Surgery is usually only performed on these fractures if the patient is a high-performance athlete or there is no radiographic evidence of healing after 6-8 weeks of immobilization.

A diaphyseal stress fracture is diagnosed when there is a history of gradually increasing pain over the lateral aspect of the foot (often associated with weight-bearing or exercise), radiographic evidence of a stress phenomenon in the bone, and no history of treatment for a fifth metatarsal fracture. These fractures, along with Jones fractures that do not heal, are best managed operatively with either closed axial intramedullary-screw fixation or autogenous corticocancellous grafting.