Iselin’s disease is an osteochondrosis or traction apophysitis of the fifth metatarsal base at the attachment of the peroneus brevis tendon. It was first described by a German physician, Dr Hans Iselin in 1912. The apophysis at the tuberosity of the fifth metatarsal tends to appear around the age of 10 for females and the 12 for males. Generally, the apophysis fuses within about a year after it appears. The condition is thought to be often under-reported and under recognized.
Almost all cases are associated with higher levels of athletic activity so is most likely due to repetitive minor trauma. 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.
Insidious onset of pain at the base of the fifth metatarsal that is aggravated with activity
Sometimes present with a limp and/or walk with everted foot.
Many have some swelling
Sometimes local tenderness and pain on resisted inversion
X-ray: fragmentation, irregularity, cystic changes around the apophysis; widening of the apophysis.
Activity limitation and restriction or total rest appears to be most effective
Short term use of strapping and foot orthotic designs to reduce activity of peroneus brevis
Cast or CAM boot immobilization
Return to activity plan
May resolve spontaneously as apophysis fuses to due natural history of skeletal maturity.
Iselin's Disease (Podiatry Arena)
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