Iselin’s Disease

I want to talk for a couple minutes about pain on the outside of the foot in children, particularly a very common problem called Iselin’s disease. Now Iselin’s disease is a type of what’s called an apophysitis. An apophysis is another name for a growth plate and “itis” means inflammation, so this is actually the inflammation of the growth plate, and it’s on the outside of the foot, right at the base of the fifth metatarsal bone. So, when we’re born this bone is mostly cartilage, as we grow it starts to become bone. But it grows from two spots, one spot’s up here and one spot’s down there, and between the ages of eight and about thirteen, there’s a space between these two areas of bone, that’s the apophysis of the growth plate, and that’s the weakest portion of that bone.

Now, let’s look over at this picture here, attaching into the base of that bone is a tendon, it’s called the peroneus brevis tendon, and it pulls right on this area here.

So this is a problem that’s very common in athletes, child athletes like soccer players, lacrosse players, that type of thing where they might start to turn their foot a little bit or they’re just a little bit too active, that tendon is tugging on this area and they start to get this achy type of pain, sometimes sharp on the outside of their foot. Fairly easy to treat, our primary goal is to reduce tension on that tendon initially and try and decrease the inflammation. Initially we will often use an over-the-counter arch support. With children, if we can avoid doing custom orthotics we usually will, because they have this tendency to grow out of them of course, but there are some very good over-the-counter supports that work.

We might do some special types of wedging on that device that will push the foot this way and take some more tension off of there and helping Iselin’s disease. We’ll do that along with using some icing and other anti-inflammatory measures.

If it’s not healing, we might put the child in a boot for a week or two and let it calm down. Some other conditions that can occur in this area might be inflammation of the tendon itself, could be a small fracture, so these are definitely things that you want to get checked out. But the most common cause of pain on the outside of the foot is Iselin’s disease or apophysitis, it’s usually very amenable to treatment, but it does require getting some tension off of that.

So, if you have a child with this type of pain on the outside of their foot (Iselin’s disease), please make an appointment to see us if you are in our area, or if you’re not in our area find another podiatrist that has a specialty with treating children..

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