Iselin's disease

Iselin Disease With a Rare Presentation in an Elderly Patient: A Case Report

We report the case of a 55-year-old female with a rare presentation and different pathophysiology of Iselin's disease. Iselin's disease is a rare condition caused by traction apophysitis of the peroneus brevis tendon at the base of the fifth metatarsal bone. It is usually a case in the adolescent age group due to their repetitive use of the peroneus tendon in daily activities, but not in the elderly group.  This type of apophysitis is rare and easily missed or misdiagnosed as a fracture in the base of the fifth metatarsal bone. However, a simple radiographic image can confirm the diagnosis. In this case, we aim to raise awareness of Iselin's disease for better comprehension of the clinical presentation, differential diagnosis, radiological features, management, and prognosis of Iselin's disease.

Iselin's Disease: A Systematic Review

Iselin's disease was first described in 1912. It is a condition affecting the tuberosity of the base of the fifth metatarsal. It has been described as a traction apophysitis predominately affecting adolescents, in particular those who partake in regular sporting activity. The condition is rarely reported and likely to remain undiagnosed, possibly mistaken for a fracture. The present report reviewed the available published data to highlight this condition as a differential diagnosis in patients with fifth metatarsal pain. Investigations, treatments and outcomes into this condition are described, to support the management and diagnosis of this condition.

Kickboxing power hour: case report of fifth metatarsal apophysitis (Iselin disease) and its magnetic resonance imaging features

Youth now-a-days are getting more involved in mixed martial arts, with increasing number of cases of lateral foot pain due to various causes. The differential diagnoses of lateral foot pain in the pediatric population include avulsion fracture of the fifth metatarsal base, Jones fracture, diaphyseal stress fracture as well as os vesalianum pedis. We present a case of a 15-year-old athletic boy who presented with left lateral foot pain for a few weeks. The patient was actively involved in Kickboxing as well as active running. Left foot radiographs were normal, including normal radiographic appearance of the fifth metatarsal apophysis. Due to ongoing pain, magnetic resonance imaging of the left foot was performed, which revealed apophysitis of the fifth metatarsal, known as Iselin disease. Iselin disease has been postulated to be caused by traction on the fifth metatarsal apophysis by performing sidekicks or round kicks during the kickboxing practice. Iselin disease should be suspected in young children of 10-15 years age involved in physical activity presenting with lateral foot pain. Magnetic resonance imaging is extremely useful to correctly diagnose this condition and avoid misdiagnosis of a fracture.

Treatment outcomes of adolescents with Iselin's apophysitis

This study assessed the presentations and outcomes of patients treated for Iselin's apophysitis. A total of 27 patients with Iselin's apophysitis were retrospectively analyzed for presentation, treatment, and clinical outcome. The mean age of presentation was 11.5 years (range: 9.2-15 years). All patients played sports, and their symptomatic severity and acuity varied. Treatments included rest, footwear modification, use of a controlled ankle movement boot, and use of a post-op shoe. Treatment lasted for an average of 24 days (range: 14-33 days), and the average time to return to play was 38 days (range: 14-53 days). All cases healed, with three reinjuries and no nonunions. Six cases were initially misdiagnosed as a fracture or tendonitis, indicating the need for further education on the diagnosis and natural history of Iselin's apophysitis.

Foot pain in the child and adolescent

There are multiple causes of pediatric foot and ankle pain. Although conservative measures are appropriate for initial management, patients with refractory pain should be given consideration for further intervention. This review highlights some of the most common causes of foot and ankle pain in the child, with specific attention to demographics, etiologies, diagnostic workup, and treatment options.

Traction apophysitis of the fifth metatarsal base in a child: Iselin's disease

Although Iselin's disease, apophysitis of the fifth metatarsal base, is not infrequent in clinical practice, it is accepted as a rare cause of lateral foot pain in young adolescents. Usually a simple clinical examination and radiographs are sufficient for diagnosis. We present a patient with Iselin's disease and discuss its clinical and radiographic characteristics, differential diagnosis, aetiopathogenesis and treatment.

Iselin’ Disease - Apophysitis of the Fifth Metatarsal Base: Report of Two Cases

Iselin’ disease is a benign adolescent growth disturbance of the base of the fifth metatarsal called epiphysitis or apophysitis by others caused by abnormal traction of peroneus brevis tendon. This abnormality is rarely reported in medical literature, probably due to the benign nature and spontaneous healing in almost all cases. The affection should be known to medical specialist like orthopedists, radiologists, physical therapists and pediatricians. The differential diagnosis is made with Jones’ fracture of the fifth metatarsal and os vesalianum which is a congenital anomaly. We present two our cases with their similarities in clinical findings, typical radiologic images and complete relief from symptoms with conservative treatment.

Pediatric overuse injuries in sports

Overuse injuries in the pediatric and adolescent population are a growing problem in the United States as more children participate in recreational and organized sports. It is not uncommon for children and adolescents to play on multiple teams simultaneously or to be involved in sports year-round. Without adequate rest, the demands of exercise can exceed the body's ability to repair tissues, leading to repetitive microtrauma and overuse injury. Unlike in adults, the consequences of overuse injury in the pediatric and adolescent athlete are far more serious because the growing bones are vulnerable to stress. The ability to identify individuals who are at risk of overuse injuries is key so that education, prevention, and early diagnosis and treatment can occur. Preventive measures of modifying training factors (ie, magnitude, intensity, and frequency of sports participation) and correcting improper biomechanics (alignment, laxity, inflexibility, and muscle imbalance) should always be part of the management plan.

Lower limb injuries in children in sports

This article presents an overview of sports-related injuries of the lower limb in children, with emphasis on the management. The special injury-related conditions of childhood, epidemiology, and the particular pattern of injuries are discussed. The increased participation of children in sports will continue. Permanent damage is a risk, and, as such, prevention should be the most important management in this age group. For example, stretching exercises should be performed with "warm" muscles. Excessive weight training has an unacceptable risk of injury. In endurance sports, the "10 percent rule," which consists of increasing activity by 10% each week, probably could be applied to prevent overuse injuries. A multifactorial approach may be helpful. The rationale for high performance, competitive sports for children is doubtful. The optimal levels of safe training will remain changeable and not predictable. It should be the responsibility of parents, coaches, and healthcare professionals to try and minimize the potential for injury and disability, and allow children to enjoy the benefits of sports.

Iselin's disease: a case presentation of nonunion and review of the differential diagnosis

The confusing pathology of the proximal fifth metatarsal can make Iselin's disease difficult to distinguish from Jones', avulsion, or stress fractures, or os vesalianum. While lselin's disease appears to be rare due to the scarcity of cases in the medical literature, this may be due to misdiagnosis. The case report discusses the course of treatment for a young male with Iselin's disease that developed into a nonunion. The differentiating factors of the above-mentioned fractures are discussed.

Pediatric sports injuries: when to refer or x-ray

When any athlete presents for evaluation of an injury, the history and physical examination is of paramount importance in establishing a differential diagnosis. A radiograph is often used to confirm a diagnosis or to reassess an injury following treatment failure. There are certain drawbacks involved with getting a radiograph including cost, inconvenience, radiation exposure, and misinterpretation. Therefore, the radiographic evaluation of the injured athlete should be used only as clinically necessary. The benefits of getting a radiograph, to allow assessment of the severity of the injury, and thereby allow a more appropriate and aggressive treatment and rehabilitation program. The skills of history taking and physical examination presented in this article should make it easier to decide when the child athlete needs a more comprehensive and aggressive evaluation including radiographic studies.