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http://upload.orthobullets.com/topic/4073/images/iselin_s.jpg
http://upload.orthobullets.com/topic/4073/images/os_vesalianum.jpg
http://upload.orthobullets.com/topic/4073/images/apophysis_and_fx_5th_mt.jpg
Introduction
  • Iselin's disease is a traction apophysitis of the tuberosity of the fifth metatarsal
  • Epidemiology
    • demographics
      • most often seen in physically active boys and girls between the ages of 8 and 13 years of age
    • risk factors
      • common in soccer players, basketball players, gymnasts, dancers, and other sports with repetitive inversion stresses
  • Pathophysiology
    • due to repetitive traction of peroneus brevis tendon at the site of its attachment
Anatomy
  • Osteology
    • fifth metatarsal apophysis
  • Muscles
    • peroneus brevis tendon insertion 
Presentation
  • History
    • often no history of trauma
  • Symptoms
    • pain in lateral foot
      • worse with activity and improves with rest
  • Physical exam
    • inspection
      • swelling and erythema
    • palpation
      • tenderness over base of 5th metatarsal at the insertion of peroneus brevis
    • provocative test
      • pain with resisted eversion and extreme plantar flexion
Imaging
  • Radiographs
    • may show an enlarged apophysis with disordered ossification and widened chondro-osseous junction 
Differential
  • Normal apophysis 
    • longitudinally oriented apophysis without fragmentation 
  • Base of 5th metatarsal fractures 
    • transverse orientation of fracture fragment differentiates it from nearby vertically oriented apophysis 
    • may be difficult to differentiate in adolescents
  • Os vesalianum 
    • intratendinous accessory bone within the substance of the peroneus brevis  
    • often incidental but can be associated with pain
Treatment
  • Nonoperative
    • stretching, rest, activity modification, icing
      • indications
        • standard of care as conditions resolves with time
    • cast immobilization
      • indications
        • pain despite attempts at other non-surgical management
  • Operative
    • surgical excision
      • indications
        • pain despite immobilization and other non-surgical management 
        • nonunion
Complications
  •  Nonunion
    • rarely occurs
 

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