Iselin’s disease is a condition caused by traction apophysitis of the base of the fifth metatarsal bone. It is seen most commonly in adolescents participating in sports that involve running and jumping. Children with tight calf muscles are also more susceptible to this overuse injury.

This condition is painful and can prevent your child from continuing their favourite activities. It typically resolves once the growth plates fuse, usually by age 12.

Symptoms

Symptoms of Iselin’s disease are pain and tenderness on the outside of the foot near the base of the fifth metatarsal bone, just behind the small bump that can be felt with your finger when you move your finger along the outer edge of your child’s foot. It is most common in active boys and girls between the ages of 8 and 13, especially those involved in sports that require running, jumping and/or pivoting. The pain is caused by repetitive pressure and/or tension on the growth plate (apophysis) at the base of the fifth metatarsal where one of the calf muscles inserts. Tight calf or peroneal muscles are a risk factor for this condition as they increase the tension placed on the growth plate during physical activity.

A physical examination of your child’s foot and gait analysis will help your doctor make the diagnosis. X-rays are usually not required, but may be ordered to exclude other pathologies that occur in this area, such as Jones fracture, avulsion fracture or Os vesalianum.

The good news is that Iselin’s disease typically resolves on its own over time, with rest, ice, stretching and changing to more supportive footwear. If left untreated, it can lead to persistent and painful symptoms that can interfere with your child’s daily activities, as well as their favourite sports and other physical activities with friends.

Diagnosis

Iselin’s disease develops due to repetitive pressure or tension on the growth center at the base of the fifth metatarsal. This area of the foot is particularly vulnerable as it is still growing and more sensitive to injury than mature bone. It is commonly seen in children that are active and involved in sports that require repetitive stress or jumping. It can also be caused by tight calf muscles, which can increase the tension on this area of the foot, or an abnormal foot posture (flat feet).

Typically, children complain of pain along the outside edge of their foot that is worse with activity and better with rest. The skin in the area of the pain may appear red and warm to touch.

The diagnosis of Iselin’s disease is based on a physical examination by a podiatrist, who specializes in treating children’s feet. He or she will review the child’s symptoms and perform a foot assessment, including a gait analysis and inspection of their shoes to look for abnormal wear patterns. X-rays are not required, but may be obtained to rule out a fracture in the area of the painful metatarsal.

Treatment for Iselin’s disease involves a period of rest from sports activities to allow the painful metatarsal to heal. This can be difficult for active children who are losing out on their favorite activities, but this is important to allow the injury to heal and prevent long-term problems. In some cases, your doctor may recommend a short period of immobilization in a walking boot or cast to keep the area protected and reduce inflammation.

Treatment

Iselin’s disease is an overuse injury causing repetitive pressure and tension on the growth center at the base of the fifth foot bone (metatarsal). Jumping, running and other athletic activities generate a lot of stress on this area. Tight calf muscles are also a risk factor. The pain is typically worse with activity and improves with rest. The area may be enlarged, red and painful to the touch.

Diagnosing Iselin’s disease is usually based on history and physical examination of the feet. A gait analysis is often performed to evaluate foot and leg muscle strength and balance. The doctor will also look for underlying foot posture abnormalities that can contribute to the development of Iselin’s disease. X-rays are not always necessary to make the diagnosis, but they can be helpful in evaluating the area for other pathologies such as a Jones fracture, avulsion fracture or Os vesalianum.

Most cases of Iselin’s disease will resolve on their own. Your doctor will recommend icing the area, relative rest from your child’s activity and a change to more supportive footwear. If symptoms persist, a pediatric immobilization brace can be used to offload the area and allow for healing. Iselin’s disease will generally resolve when the growth plates fuse which is usually around age 12 in girls and 14 in boys.

Prevention

The best way to prevent Iselin’s disease is to encourage kids and teens to warm up and stretch properly before engaging in physical activity. This can help prevent tightness in the peroneals and calves, which reduces the amount of stress placed on the growth plate. Children and teens should also listen to their bodies, taking rest days when needed. If they do experience foot pain while participating in sports or other activities, they should see our podiatrists for prompt diagnosis and treatment.

While the name of Iselin’s disease sounds alarming, this is a temporary condition that will resolve as the bones reach maturity and stop growing. To relieve symptoms, our podiatrists will typically recommend resting, icing, stretching and switching to more supportive footwear. In rare cases, surgery may be recommended, but this is a last resort. To learn more about Iselin’s disease and our effective treatment options, contact us today. We look forward to helping your child enjoy all of their favorite activities pain-free!