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Updated: Jun 17 2021

Iselin's Disease

  • summary
    • Iselin's Disease is a common acquired condition cause by traction apophysitis of the the peroneus brevis tendon at the tuberosity of the fifth metatarsal in children and presents with lateral foot pain. 
    • Diagnosis is made clinically with pain over the 5th metartarsal base with radiographs showing an enlarged apophysis with disordered ossification and widened chondro-osseous junction.
    • Treatment is usually nonoperative with activity modifications, stretching, and a short period of cast immobilization as the condition typically resolves over time.
  • 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
  • Etiology
    • 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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