Jones Fracture Rehab Protocol

Below is a general guideline for rehab after a fifth metatarsal fracture.  This can be adjusted for "in-season" vs "out-of-season" demands with a more aggressive timeline.

Phase 1: Immediate Postoperative (Weeks 0-4)

Goal: Protect the surgical repair and manage swelling.

- Weight-Bearing: Non-weight-bearing (NWB) for the entire phase.

- Immobilization: Cast or post-op splint to protect the foot.

- Exercises:

  - Toe ROM: Gentle range of motion exercises for toes to prevent stiffness.

  - Ankle pumps and circles: To promote circulation and prevent stiffness, without stressing the fracture site.

  - Core and upper body strengthening: Maintain overall conditioning.

Precautions:

- Keep the foot elevated to control swelling.

- Monitor for signs of complications (e.g., infection, excessive swelling).

Phase 2: Early Weight-Bearing (Weeks 4-8)

Goal: Begin controlled weight-bearing, continue protecting the surgical site.

-Weight-Bearing: Partial weight-bearing (PWB) initiated at 4 weeks, progressing as tolerated.

- Immobilization: Transition to a walking boot (with crutches as needed).

- Exercises:

  - Continue **toe ROM** and **ankle mobility** exercises.

  - **Isometric strengthening** of lower leg (without significant stress on the foot).

  - Begin **gentle resistance exercises** for the ankle (e.g., banded dorsiflexion, inversion/eversion) by Week 6.

  - Proprioception training: Start light, non-weight-bearing balance exercises to enhance proprioception.

Precautions:

- Avoid high-impact activities.

- Ensure progressive increase in weight-bearing without pain or swelling.

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Phase 3: Full Weight-Bearing in Boot (Weeks 8-12)

Goal: Transition to full weight-bearing and wean off the boot.

- Weight-Bearing: Progress to full weight-bearing as tolerated in the boot.

- Immobilization: Continue using the boot until Week 8, then transition to normal footwear with a carbon fiber insert.

- Exercises:

  - Full range of motion (ROM) exercises for the ankle and foot.

  - Progress to **weight-bearing balance and proprioception training (e.g., single-leg stance, balance board).

  - Resisted strengthening exercises: Start lower leg resistance exercises, focusing on calf raises and toe curls.

  - Aquatic therapy: If available, begin low-impact water-based exercises.

Precautions:

- Ensure no limping during walking in the boot or after transitioning to regular footwear.

- Monitor for any signs of pain during full weight-bearing.

Phase 4: Return to Sport-Specific Training (Weeks 12-16)

Goal: Restore functional strength, mobility, and endurance.

- Weight-Bearing: Full weight-bearing in normal footwear with the carbon fiber insert.

- Exercises:

  - Progress to **single-leg strengthening exercises** (e.g., single-leg squats, lunges).

  - **Advanced balance and proprioception** drills (e.g., dynamic balance, agility drills).

  - **Sport-specific drills**: Gradually reintroduce running, cutting, and jumping mechanics.

  - Continue **calf strengthening** and **foot intrinsic muscle training**.

**Precautions**:

- Avoid high-impact or competitive play until cleared by a physician and confirmation of radiographic healing

- Gradual return to sport-specific activities is crucial to prevent re-injury.

Phase 5: Return to Play (Weeks 16 and beyond)

Goal: Achieve full functional recovery and safe return to competitive soccer.

- Exercises:

  - Full participation in practice with close monitoring.

  - Continue strength and conditioning for lower extremity, focusing on explosive movements and agility.

  - Plyometrics and sport-specific drills: Progress intensity gradually.

- Return to Play: Full clearance based on clinical exam, functional testing, and imaging if necessary.

Dislcousre!: This protocol should be adapted based on the athlete’s recovery, symptoms, and functional progress.

Goal: Protect the surgical site and manage swelling.

• Weight-Bearing: Non-weight-bearing (NWB) for the first 2 weeks.
• Immobilization: Boot applied immediately post-op to protect the foot.
• Exercises:
  • Toe ROM: Gentle range of motion for toes to prevent stiffness.
  • Ankle pumps and circles: To promote circulation without stressing the fracture site.
  • Core and upper body strengthening: Maintain conditioning without stressing the lower limb.
  • Isometric quad and glute exercises: To prevent muscle atrophy.

Precautions:

• Elevate the foot to control swelling.
• Avoid any weight-bearing on the operated foot.
• 
  

Goal: Begin progression to full weight-bearing.

• Weight-Bearing: Partial weight-bearing (PWB) in the boot beginning at Week 2, progressing to full weight-bearing (FWB) by Week 4.
• Immobilization: Continue using the walking boot.
• Exercises:
  • Continue toe ROM and ankle mobility exercises.
  • Isometric strengthening of the lower extremity: Gentle activation of muscles (e.g., quads, glutes).
  • Proprioception exercises: Begin light seated balance exercises.
  • Maintain upper body and core strengthening.

Precautions:

• Avoid overloading the fracture site during weight-bearing.
• Ensure gradual progression to FWB without pain.

Goal: Transition from boot to normal footwear with a carbon fiber insert and increase mobility.

• Weight-Bearing: Full weight-bearing in a shoe with a carbon fiber insert starting at Week 4.
• Immobilization: No longer using the boot, transitioning to normal shoes with the insert.
• Exercises:
  • Ankle and foot ROM: Continue to restore full mobility.
  • Balance and proprioception training: Single-leg balance, stability exercises.
  • Strengthening exercises: Begin more dynamic strengthening such as calf raises, banded ankle movements.
  • Low-impact conditioning: Biking, swimming, or elliptical work to maintain cardiovascular fitness.

Precautions:

• Ensure pain-free full weight-bearing in shoes with the carbon fiber insert.
• Avoid high-impact or twisting movements.

Goal: Prepare for return to soccer with progressive functional drills.

• Weight-Bearing: Full weight-bearing with a carbon fiber insert in regular shoes.
• Exercises:
  • Sport-specific conditioning: Begin light running, forward/backward drills, and low-intensity soccer-specific movements.
  • Continue strengthening exercises for the foot, ankle, and lower leg.
  • Plyometric exercises: Begin with low-impact hopping, progressing to more dynamic drills.
  • Proprioception and agility training: Lateral movements, cutting, and directional change exercises.

Precautions:

• Closely monitor for any signs of pain or swelling as activity levels increase.
• Gradually reintroduce intensity of soccer drills and functional movements.

Goal: Full return to competitive soccer.

• Weight-Bearing: Full weight-bearing with a carbon fiber insert in normal footwear.
• Exercises:
  • Sport-specific training: Progress to full-speed running, cutting, and directional changes.
  • Strength and endurance conditioning: Continue strengthening lower extremities and maintaining cardiovascular fitness.
  • Plyometric and agility drills: Ramp up explosive movements and dynamic drills.

Return to Play:

• Full clearance for soccer practice and competitive play by Week 8, pending functional tests and medical approval.
• Continue monitoring for any signs of discomfort or re-injury.