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Iselin’s Disease

What is Iselin’s Disease?

Iselin’s Disease is pain around the base of the little toe (5th metatarsal) that may radiate down the lateral (outside) of the foot. Commonly a sharp/aching sometimes ‘bruised’ type of pain. This is

Iselin's Disease
Inflammed growth plate in Iselin’s disease in a child.

often associated with localized swelling and redness. Pain typically gets worse with activity occasionally resulting in a ‘limp’.

Who gets Iselin’s Disease?
Common in children between 8-16 years old especially those that are physically active.  Adults cannot get Iselin’s disease as the growth plate closes over and turns into bone with skeletal maturity at approximately 16 years old.

What causes Iselin’s Disease ?
In children up to the age of about 16 years old the bones in the feet still have growth plates present. These growth plates are made up of soft cartilage that eventually hardens and fuses once growth/development has slowed or been completed.

There is an epiphysis (growth plate) that is situated on the base of the 5th metatarsal (little toe). Directly around this area is also an important attachment area for the peroneal tendon. This tendon runs all the way from just below the lateral knee down the lateral (outside) of the shin to insert onto the outside of the foot.

Over-activity or repetitive stress of this tendon with regular sports/activities causes the tendon to become acutely inflamed and irritated.

At the same time in a growing child there are typically phases of rapid bone growth. The surrounding muscles and tendons then have to play ‘catch up’ to this growth so can often be shorter and tighter than normal.

The combination of acute inflammation from repetitive stress, with a short and tight peroneal tendon due to rapid growth results in excess tension and inflammation on the growth plate (epiphysis). The end result is pain, swelling and occasionally bone or cartilage over growth around the base of the little toe (5th metatarsal).

How can we fix Iselin’s Disease? Iselin’s disease should initially be treated by the RICE (Rest Ice Compression Elevation). A reduction in sports/activities is necessary to reduce repetitive stress on the growth plate and allow repair of the growth plate to take place.

A Podiatrist can also play a vital role in the rehabilitation process of Iselin’s disease. Over-activity or repetitive stress of the peroneal tendon may arise from biomechanical abnormalities within the leg or foot. This can cause the peroneal tendon to work harder than normal to stabilize the foot. A Podiatrist can assess the lower limb mechanics and discuss the use of orthotics to manage this.

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