Iselin disease (apophysitis of the 5th metatarsal)

Iselin disease is painful irritation and inflammation of the apophysis (growth plate) at the base of the 5th metatarsal (foot bone), where one of the calf muscles inserts. In a child, the bones grow from areas called growth plates. The growth plate is made up of cartilage, which is softer and more vulnerable to injury than mature bone. Iselin disease is most often seen in physically active boys and girls between the ages of 8 and 13 years of age. It is most common in soccer, basketball gymnastics and dance.

How it occurs

Iselin disease is an overuse injury caused by repetitive pressure and/or tension on the growth center at the base of the fifth metatarsal. Running and jumping generate a large amount of pressure on the forefoot. Tight calf muscles are a risk factor for Iselin disease because they increase the tension on the growth center.

Signs and symptoms

Your child will complain of pain along the outer edge of the foot that is worse with activity and improves with rest. She may limp or walk on the inside of the foot. The growth center may be enlarged, red, and painful to the touch.

Diagnosis

Your doctor can diagnose Iselin disease based on a review of your child’s symptoms and physical examination of the foot. X-rays are not required to make the diagnosis. Your doctor may order x-rays to evaluate for other causes of foot pain. X-rays will show the growth center, but the inflammation (apophysitis) cannot be seen on an x-ray.

Treatment

Your child will need a short period of rest from painful activities in order to take pressure off the growth center and allow the inflammation to resolve. Ice is very helpful in reducing pain and inflammation. Apply ice for 10-15 minutes as often as every hour when sore. Do not use ice immediately before activity. It is very important to stretch tight calf muscles in order to relieve tension on the growth center. If rest, ice, and stretching do not relieve the pain, your doctor may prescribe an anti-inflammatory medication. Shoes that fit well and have good arch support can decrease the pain. Depending on your foot shape and structure, your doctor may recommend custom-molded shoe inserts. In severe cases, 2-4 weeks of immobilization a walking cast or boot may be necessary.

Returning to activity and sports

The goal is to return your child to her sport or activity as quickly and safely as possible. If she returns to activities too soon or plays with pain, the injury may worsen. This could lead to chronic pain and difficulty with sports. Everyone recovers from injury at a different rate. Your child’s return to sport or activity will be determined by how soon her injury resolves, not by how many days or weeks it has been since the injury occurred. In general, the longer your child has had symptoms before starting treatment the longer it will take for the injury to heal. Your child may return safely to her sport or activity when each of the following is true:

• She has full range of motion of the ankle without pain.
• She has no pain at rest.
• She is able to walk without pain.
• She is able to jog without pain.
• She is able to sprint without pain.
• She is able to jump and hop on the affected foot without pain.

If the pain recurs when she returns to sports, she should rest, ice and stretch until the pain is gone before trying to return again.

Preventing apophysitis of the 5th metatarsal

• Perform a proper warm-up before starting any activity. Ten minutes of light jogging, cycling, or calisthenics before practice will increase circulation to cold muscles, making them more pliable so that they put less stress and tension on their attachment sites (apophyses).
• Wear shoes that fit well and are appropriate for the activity. Replace worn-out shoes promptly.
• Stretch tight muscle groups. The ideal time to stretch is after exercise. Hold each stretch for 30 seconds. Don’t bounce.
• Do not play through pain. Pain is a sign of injury, stress, or overuse. Rest is required to allow time for the injured area to heal. If pain does not resolve after a couple days of rest, consult your physician. The sooner an injury is identified, the sooner proper treatment can begin. The result is shorter healing time and faster return to sport.