Iselin’s disease is a rare osteochondrosis or traction apophysitis of the fifth metatarsal base at the attachment of the peroneus brevis tendon that causes lateral foot pain. The apophysis at the tuberosity of the fifth metatarsal tends to appear around the age of 10 for females and the 12 for males. Age 13 appears to be the most common age for the onset of Iselin’s disease to occur and it affects girls and boys equally – girls seem to get this at a younger age than boys. Generally, the apophysis fuses within about a year after it appears. The condition is thought to be often under-reported and under recognized.
Iselin’s disease was first described in 1912 in the the American Journal of Orthopedic Surgery by the German physician, Hans Iselin (1878- 953) who at the Basel Polyclinic Switzerland. Iselin described it as “…a disease exhibiting the same phenomena as the so-called Schlatter’s (Osgood) disease of the tuberosity of the tibia. The tendon of the peroneus brevis, bearing the same relationship to the metatarsal tuberosity as the patellar tendon to the tuberosity of the tibia.”
Iselin H: Disturbances due to growth at the time of ossification of the tuberosity of the fifth metatarsal. American Journal of Orthopedic Surgery. 10:487, 1912
Almost all cases are associated with higher levels of athletic activity so is most likely due to repetitive minor trauma. It is more common in children in sports with more ‘inversion’ or lateral activities such as basketball and tennis. A laterally deviated subtalar axis will increase the pull of peroneus brevis tendon due to the shorter lever arm. A higher level of metatatarsus adductus angle may be related.
The 2024 ICD-10-CM Diagnosis Code of M92.7 is the most applicable (juvenile osteochondrosis of metatarsus).
Clinical Features of Iselins Disease:
Insidious onset of pain at the base of the fifth metatarsal that is aggravated with activity. Usually there is no history of an acute injury.
Tenderness on palpation of the the base of the fifth metatarsal.
Sometimes present with a limp and/or walk with everted foot.
Many have some swelling
Pain on resisted inversion
X-ray: fragmentation, irregularity, cystic changes around the apophysis; widening of the apophysis.
Differential diagnosis: fifth metatarsal fracture (Jones fracture); fifth metatarsal stress fracture; cuboid syndrome; symptomatic os vesalianum; traction spur with osteophyte formation | Locked cuboid | Weasel toe | Referred pain from peroneal trigger points.
Treatment of Iselin Disease:
Will probably resolve spontaneously as apophysis fuses to due natural history of skeletal maturity.
Activity limitation and restriction or total rest appears to be most effective
Nonsteroidal anti-inflammatory drugs and ice for pain management
Short term use of strapping and foot orthotic designs (eg lateral wedging) to reduce activity of peroneus brevis
Cast or CAM boot immobilization
Return to activity plan after 4-6 weeks of rest. Peroneal strengthening exercises may be needed as part of the rehabilitation if weaker.
Most severe non-responsive cases may need a surgical excision especially if the apophysis develops into a non-union.
External Links:
Iselin’s Disease (Podiatry Arena)
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