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Does anybody have any useful articles/references regarding Iselin's disease? I have an 11 year old patient that I think has this, but cannot find much literature to help me.

She has had right lateral foot pain for approximately 4 months and has a minimally enlarged styloid process on the affected foot, with pain on prolonged activity. She is a very sporty girl (Netball, Hockey, Lacrosse etc) with particularly unstable subtalar/midtarsal areas but wears ballet-style shoes with a kitten heel (half inch) to school :bang:

The styloid process is painful on palpation, with some mild tenderness around the lateral malleolus/peroneus brevis tendon.

My instinct is to deal with the instability/footwear issues and await resolution. Does anyone have any thoughts/ideas? GP reluctant to order x-ray at this stage. Incidentally, the right foot is approximately 1 size smaller than the left :confused:

Any advice gratefully received.

Ella

 

Ella:

I don't know if you can properly diagnosis Iselin's disease without an x-ray, but it certainly seems a likely possibility. Regardless of the proper radiographic diagnosis, you may consider that this young lady has increased peroneus brevis contractile activity due to a laterally deviated subtalar joint (STJ) axis. The peroneus brevis muscle will be especially active in the side-to-side sports she is involved with. Put a 3-6 mm valgus in-shoe wedge on her shoe insole with adhesive felt or other similar material as illustrated below. This wedge will increase the external STJ pronation moments that should then decrease the contractile activity in the peroneus brevis muscle during her weightbearing activities (Kirby KA: Subtalar joint axis location and rotational equilibrium theory of foot function. JAPMA, 91:465-488, 2001). Have her use this "temporary orthosis" in all her shoes and give her specific shoe recommendations that this insole will work with. When the valgus-wedged insole is combined with daily icing therapy, I would expect her pain to be at least 50-75% better within two weeks. Please keep us all informed of her progress for the education of everyone following along.

 

Information on Iselin's is hard to come by. This is the extent of the lecture notes I give the students:

 

Thanks Kevin - That's very useful. I have given her an insole to that design and will report back on how she gets on.

Ella

 

I have also found that the good old firm foot taping can be of benefit to these patients.

Showing the mother/father how to tape appropriately means they can be supported for their activity time and then removing for night time/times of in-activity.

Gareth

 

http://scholar.google.co.uk/scholar?q= Iselin's Disease&hl=en&lr=&btnG=Search

 

Ella-

Here is an ER point: If it hurts, you X-Ray it. Get comparison views in an 11 y.o.

If inconclusive, have the GP involved and get an MRI.

The valgus wedge is a good point as well!


Bill Dotzman, DO, DPM
:cool:

 

Bill

Thanks for your advice - trouble is, here in UK (the NHS) I can't just order x-rays myself. I have to involve the GP and unfortunately he doesn't want to get any at the moment. We are working on those in authority to allow us to order x-rays ourselves, but it's in a long and frustrating bureaucratic process involving public funding issues etc ! Hopefully shouldn't be too much longer!

Ella

 

I did not know that. Keep on the GP, it is good practice here in the States to take some pictures.

Good luck!

Bill D.

 

I saw the same little girl again yesterday and am pleased to report that she is feeling much better. Her symptoms have almost completely resolved with Kevin's insole design, as advised in an earlier posting.

Thank's for your advice Kevin - :drinks

I will, of course, be monitoring her until complete resolution and then may to need to address her instability issues.

 

Ella:

Thanks for the update on your patient. I'm glad the young lady is able to be more comfortable in her sports now.

This is a great example demonstrating that with good biomechanical theory, even simple insole modifications may be used to effectively heal seemingly difficult-to-treat pathology.

 

Ella

Ran across these references, recently

http://www.ankleandfootcare.com/research.html
http://www.ankleandfootcare.com/research/jfas_vol38_no6.pdf
http://www.aafp.org/afp/990501ap/2516.html
http://www.physsportsmed.com/issues/2002/12_02/anderson.htm
http://www.latrobe.edu.au/podiatry/pod32psp/paediatrics_lecture_9.htm
http://www.uphs.upenn.edu/ortho/oj/1998/oj11sp98p36.html

toeslayer

 

Here are a couple of PDF's that mention or are directly related to Iselin's.

Glad Kevin's modification worked out for your patient.

Bruce

 

From ProLab:
Foot Orthotics for Iselin’s Disease

 

Traction apophysitis of the fifth metatarsal base in a child: Iselin's disease.
Deniz G, Kose O, Guneri B, Duygun F.
BMJ Case Rep. 2014 May 15;2014. pii: bcr2014204687. doi: 10.1136/bcr-2014-204687.

 

I also find that an ankle equinus (satan reincarnated) can influence such cases. Due to the extrinsic pronator (P. Brevis) over working - further adding to the stress on the apophysis. :)

 

Iselin's Apophysitis: The Unappreciated Osteochondrosis of the Foot
Jillian E Sylvester, M.D., Penn State College of Medicine, Hershey, PA and William Hennrikus, M.D, Orthopaedic Surgery, Penn State/Milton S Hershey Medical Center, Hershey, PA
American Academy of Pediatrics Conference: October 11, 2014

 

Has anyone also noticed those with islin's often have residual metatarsus adductus? The more I see, it is almost a prerequisite for it, which makes sense given the attachments on and around the 5th but I just wondered others observations?

 

Treatment outcomes of adolescents with Iselin's apophysitis.
Sylvester, Jillian E.; Hennrikus, William L.
Journal of Pediatric Orthopaedics B: February 2, 2015

 

From Podiatry Today:
Pearls On Diagnosing And Treating Iselin Disease In Children

 

Kickboxing power hour: case report of fifth metatarsal apophysitis (Iselin disease) and its magnetic resonance imaging features.
Gupta N et al
Transl Pediatr. 2017 Apr;6(2):98-101. doi: 10.21037/tp.2017.03.07.

 

Iselin's Disease: Case Study and Literature Review
Thomas Mathieu et al
J Sports Med Doping Stud 2019, 9:1

 

Iselin Disease With a Rare Presentation in an Elderly Patient: A Case Report
Nibras K Aljabri et al
Cureus. 2023 Jan 18;15(1)