Iselin disease is painful irritation and inflammation of the growth plate (apophysis) at the base of the 5th foot bone (metatarsal), where one of the calf muscles inserts. In a child, the bones grow from areas called growth plates. The growth plate is made up of cartilage, which is softer and more vulnerable to injury than mature bone. Iselin disease is most often seen in physically active boys and girls between the ages of 8 and 13 years of age. It is most common 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 foot bone (metatarsal). Running and jumping generate a large amount of pressure on the forefoot. Tight calf muscles are a risk factor for Iselin disease because they increase the tension on the growth center.
Your child will complain of pain along the outer edge of the foot that is worse with activity and improves with rest. She may limp or walk on the inside of the foot. The growth center may be enlarged, red, and painful to the touch.
Your doctor can diagnose Iselin disease based on a review of your child’s symptoms and physical examination of her foot. X-rays are not required to make the diagnosis. Your doctor may order X-rays to evaluate for other causes of foot pain. X-rays will show the growth center, but the inflammation (apophysitis) cannot be seen on an X-ray.
Your child will need a short period of rest from painful activities in order to take pressure off the growth center and allow the inflammation to resolve. Ice is very helpful in reducing pain and inflammation. Apply ice for 10-15 minutes as often as every hour when sore. Do not use ice immediately before activity.
It is very important to stretch tight calf muscles in order to relieve tension on the growth center. If rest, ice, and stretching do not relieve the pain, your doctor may prescribe an anti-inflammatory medication. Shoes that fit well and have good arch support can decrease the pain. Depending on your child’s foot shape and structure, your doctor may recommend custom-molded shoe inserts. In severe cases, 2-4 weeks of immobilization with a walking cast or boot may be necessary.
Returning to Activities & Sports:
The goal is to return your child to her sport or activity as quickly and safely as possible. If she returns to activities too soon or plays with pain, the injury may worsen. This could lead to chronic pain and difficulty with sports. Everyone recovers from injuries at different rates. Your child’s return to sport or activity will be determined by how soon her injury resolves, not by how many days or weeks it has been since the injury occurred. In general, the longer your child has had symptoms before starting treatment the longer it will take for the injury to heal. Your child may return safely to her sport or activity when each of the following is true:
- She has full range of motion of the ankle without pain
- She has no pain at rest
- She is able to walk without pain
- She is able to jog without pain
- She is able to sprint without pain
- She is able to jump and hop on the affected foot without pain
If the pain recurs when she returns to sports, she should rest, ice and stretch until the pain is gone before trying to return again.
Make sure your child does the following:
A Proper Warm-Up
Perform a proper warm-up before starting any activity. Ten minutes of light jogging, cycling, or calisthenics before practice will increase circulation to cold muscles, making them more pliable so that they put less stress and tension on their attachment sites (apophyses).
Shoes That Fit
Wear shoes that fit well and are appropriate for the activity. Replace worn-out shoes promptly.