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What Is An Iselin's Disease?
Causes
Symptoms
Diagnosis
Treatment
If you ignore the injury
Prevention
FAQs

What Is Iselin's Disease?

Iselin’s disease is a type of growing pain that affects the feet in children. Specifically, it affects the outside border of the foot at the bony ‘bump’ that you can feel if you move your hand along the outside edge of your foot. This bump is known as the ‘styloid process’, and it is located at the base of your fifth metatarsal bone, approximately halfway along the outer foot.

Despite having an alarming label of a ‘disease’, Iselin’s is actually a painful but temporary growth-related condition that cannot recur after your bones reach maturity and stop growing.

What Causes Iselin's Disease?

In order to understand what causes Iselin’s disease, we need to first look at how bones grow. Before our bones mature, they contain specific cartilaginous areas called ‘growth plates’ which our body uses as a construction site to add new bone cells to, and hence grow our bones. Being a work in progress, these growth plates aren’t as strong as the rest of the bone, making them more vulnerable when tension is applied to the bone. 

While our bones grow, our muscles do too, lengthening and strengthening, and going through periods of tightness as they lengthen and keep up with the body’s growth. Many of these muscles attach to the bones, in areas close to the growth plates. This means that when the muscles pull and place tension on the bone while kids are moving and active, it’s the growth plates that become irritated and painful as a result. This is exactly what happens in Iselin’s disease, with the growth plate being present at that bony bump at the base of the fifth metatarsal, and the attaching tendon responsible for the pulling and irritation being the peroneus brevis tendon.

Symptoms Of Iselin's Disease

The most common symptom of Iselin’s disease is pain on the outside border of the foot during physical activity. You may also notice:

• The foot pain can ease with rest, and can come and go for many months, or years
  
• Kids may walk with a limp or altered gait to try to reduce the pain and pressure on the outside of their foot
  
• Swelling may be present on the outside of the foot, at the base of the fifth metatarsal
  

Another notable symptom of Iselin’s that is often observed in case studies is the lack of any identifiable injury history, trauma or infection that may otherwise explain the symptoms.

Risk Factors For Iselin's Disease

Risk factors for Iselin’s disease can include:

• Tight calf or peroneal muscles, as they may increase the tension on the growth plate during physical activity
  
• Activities that involve repeated changes in direction or heavy plyometric exercises, as they increase the tension at the insertion of the peroneus brevis tendon
  
• A history of inversion injuries

Diagnosing Iselin’s Disease

Diagnosing Iselin’s disease can be done based on the patient’s history and the physical assessment. Confidently diagnosing Iselin’s can be made difficult by other pathologies with similar presentations often occurring in the area, such as stress fractures, an avulsion fracture, or a Jones’ fracture. In these cases, x-rays can be offered to rule out other possible diagnoses, and an ultrasound can be performed to rule out any coinciding muscle or tendon injuries. 

How to know if your child has Iselin's disease

If you think that your child may have Iselin’s disease, then it’s important to bring them in to their podiatrist for an assessment and treatment. Pain never occurs for no reason, so even if the cause is not from Iselin’s, our podiatrists will work to uncover and diagnose the true cause, and treat it accordingly.

Treatment: How To Treat Iselin's Disease

Here at The Feet People, we understand that for children, it’s about a lot more than just having foot pain. It’s about being able to participate in the sports match they’ve been looking forward to all year, about being able to get outdoors and keep up with their friends, about being able to get to the park with the dog - there are so many physical, emotional, mental and social factors involved. That’s why our treatment aims to:

• Allow your child to return to sports as quickly as possible
• Enable kids to still attend the same activities and outings with their friends
  

• Prevent the pain from recurring in the future
  
• Teach kids the warning signs and strategies so that if the pain is going to return, they can detect it early, prevent it from worsening, and know how to best manage it
  
• Help kids live a healthy, happy and active life

In order to do this, we may use:

• A stretching and strengthening exercises program aimed at the calf and peroneal muscles, designed to help reduce the tension on the foot and growth plate
  
• Custom foot orthotics to help reduce the strain on the peroneus brevis with a small wedge on the outer edge of the orthotic, as well as for helping with other foot posture problems if they are adding to the strain or pressure on the growth plate
  
• Stable, supportive footwear to help offload and support the foot while it heals
  
• Padding and strapping
  
• Foot mobilisation to help support foot posture and ease any abnormal tension on the fifth metatarsal
  
• Education on how to modify physical activities to reduce pain and help limit irritation of the growth plate
• A gait analysis and other testing to see if any imbalances or dysfunctions are causing the peroneals to overwork, adding tension to the growth plate

While you’re at home, you may choose to use ice to help reduce any swelling, which can help reduce pain. If your child's pain is severe, you may use painkillers (NSAIDs) to help relieve their pain. We also recommend they rest and avoid any activities that elicit your symptoms until you’re able to see your podiatrist.

What Can Happen If I Ignore Iselin's Disease

If Iselin’s disease is ignored and left untreated, then it can cause ongoing pain for your child during physical activity, as well as much frustration from missing out on their favourite sports and activities with their friends. While Iselin’s disease is self-limiting, meaning that the symptoms will stop once the bones reach full maturity and the growth plate hardens, the painful symptoms can still persist for many weeks and months, making it a difficult time for a child.

How To Prevent Iselin's Disease

While it may be difficult to prevent Iselin’s entirely due to the nature of the condition, the best way to reduce the likelihood of developing Iselin’s is to encourage your child to stretch well and warm-up before physical activity. This helps prevent tightness in the peroneals and calves, which eases the tension on the growth plate in the foot. 

If symptoms arise, get your children seen and treated early, before the irritation to the growth plate increases - and with it your child’s pain.

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