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Iselin Disease

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Iselin Disease, Iselin's Disease, Fifth Metatarsal Apophysitis

  • See Also
  1. Apophysitis
  • Epidemiology
  1. Boys are affected at a younger age than girls
  • Pathophysiology
  1. Traction injury of peroneus brevis insertion at base of fifth Metatarsal
    1. Repeat microtrauma to peroneus brevis insertion
  • Signs
  1. Fifth Metatarsal base pain, swelling, tenderness
  2. Provocative maneuvers
    1. Resisted Eversion
    2. Passive Inversion
    3. Plantar Flexion
  • Imaging
  1. Bedside Ultrasound or XRay
    1. Fragmentation and widening of the apophysis (or normal)
  2. MRI
    1. Indicated to evaluate for alternative diagnosis (e.g. Stress Fracture suspected)
  • Differential Diagnosis
  1. Fifth Metatarsal Fracture
    1. Acute inversion injury with avulsion Fracture
  2. Os Vesalianum (normal accessory bone)
    1. Smooth rounded bone edges (contrast with irregular edges of Apophysitis)
  • Management
  1. Relative rest
  2. Hard-soled shoe (indicated if pain is severe)
  • References
  1. Achar (2019) Am Fam Physician 99(10): 610-8 [PubMed]