: Understanding This Pediatric Foot Condition introduction Iselin disease is traction apophysitis of the fifth metatarsal base and clinically presents with tenderness and pain overlying the lateral aspect of the midfoot.
: Understanding This Pediatric Foot Condition introduction Iselin disease is traction apophysitis of the fifth metatarsal base and clinically presents with tenderness and pain overlying the lateral aspect of the midfoot. It was first described by a German physician Hans Iselin in 1912. It is likely an underdiagnosed by many physicians due to lack of recognition and lack of suspicion.
However, most sports medicine physicians will likely see this in their practice, though reports show it is much less common than Osgood-Schlatter’s disease and Sever’s disease. It most commonly affects adolescents and does fall along other patterns of traction apophysitis with females being affected between ages 8 and 11 and males from 11 to 14 years old. It is often confused with a fracture at the base of the fifth metatarsal.
The secondary ossification center appears as a small fleck oriented slightly oblique to the metatarsal shaft and is located on the lateral aspect of the tuberosity of the fifth metatarsal. The peroneus brevis inserts over this apophysis before skeletal maturity. There is a paucity of evidence regarding the epidemiology of Iselin’s disease due to limited studies with most data being in the form of case reports.
Iselin’s disease can be caused by repetitive minor trauma through the force of the peroneus brevis tendon acting on the apophysis. This can result in partial avulsion of the apophysis and inflammation, and excessive force can result in complete avulsion. Thus, Iselin’s disease is often associated with sporting-type activities, with all reported cases observed in athletic individuals.
Clinical presentation can vary, but most patients will present with pain over the fifth metatarsal with weight bearing activity. It does normally present similar to other traction apophysitis with pain after activity and in particular sporting activity such as running or jumping. A history of significant trauma is usually absent, although some reports show symptoms worsen after inversion events.
If you are experiencing symptoms that may be related to iselin's disease, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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