Iselin’s Syndrome

Iselin disease is a painful inflammatory condition of the apophysis (growth plate) of the 5th metatarsal (little toe bone), where the peroneus brevis inserts.
The growth plate is the area that bone grows from in children.
The growth plate is made up of cartilage, which is softer and more vulnerable to injury than mature bone. This growth plate also serves as an attachment site for the peroneus brevis muscle and the plantar fascia.
Iselin disease is most often seen in physically active boys and girls between the ages of 8 and 13 years of age but it can occur in younger children who are particularly active.
This condition is most common in those that participate in soccer, basketball gymnastics and dance.

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.
Change of direction activity and heavy plyometric exercises are risk factors for Iselin disease because they increase the tension at the insertion of peroneus brevis.

Pain is most commonly found along the outer edge of the foot and is worsened with activity and improved with rest.
A limp on the affected side is likely to be present.
The child may walk on the inside of the affected foot to decrease tension through the insertion of peroneus brevis into the base of the 5^th
The skin overlying the base of the 5^th toe bone may be swollen, red, and/or painful to touch.

The diagnosis of Iselin Disease is made primarily by clinical presentation and physical exam. Pain with palpation at the widest part of the lateral foot is the most common sign.
Xray or ultrasound are generally not required to diagnose the disease, but they may prove useful in assessing for displacement of the growth center and excluding other causes of foot pain.

A short period of rest from aggravating activities to reduce inflammation and allow release of pressure on the tendon insertion is recommended.
Applying ice for 10 to 15 minutes every 2 to 3 hours is helpful to reduce pain and swelling. Ice is only really required to minimise pain as it won’t improve healing.
Non-steroidal anti-inflammatory medications such as ibuprofen or naproxen may also be beneficial in relieving inflammation and pain in the early stages.
Tension on the growth plate can be relieved by gentle massage of the calf and lateral shin muscles.
Properly fitting running shoes and/or arch support inserts are very helpful in decreasing pain on return to explosive activity.
If the individual fails a trial of massage, gentle stretching, rest, ice, and pain medications, the affected limb may be immobilised in a cam/walking boot for a short period until pain has decreased.

Despite having a goal to return the patient to his or her sporting activities as quickly as possible, playing with pain will not only inhibit healing of the affected growth plate but may further injury the affected foot.
Activity however is best continued but guided by pain rather than completely resting and then reloading too rapidly.
The longer the individual has been plagued by the injury, the more time is required for symptoms to resolve.
Symptom minimisation and healing, if completely detached at the growth plate, typically takes anywhere between 3-12 weeks and is likely nearing completion when the patient can meet the following:
- Completing full range of motion without ankle pain
- No pain at rest
- Ability to walk, jog, and sprint without pain
- Ability to jump and hop on the affected side without pain
If pain recurs upon returning to sporting activities don’t despair, the individual should rest, ice, massage and gentle stretch until the pain has resolved before trying to return to play again.

A dynamic and gradually increasing warm-up before starting any activity. A warm up regime such as the Fifa11+ is a great, researched warm up regime that can minimise risk of injury to the entire body.
Wear shoes that fit well and are appropriate for the activity. Replace worn-out shoes as regularly as practicable.
Stretch or massage tight muscle groups. A dynamic warm up will go a long way to loosening muscles appropriately.
Do not play through pain. Pain is a sign of injury, stress, or overuse. Decreased load or 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 physiotherapist. The sooner an injury is identified, the sooner proper treatment can begin. The result is less time not being able to play and therefore a faster return to life and sport.

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