Iselin disease

Iselin disease is a benign and self-limiting condition, defined as apophysitis of the base of the 5^th metatarsal.

Epidemiology

It is most commonly seen in males with sport injuries and is often also seen in adolescents. 

Pathology

The exact etiology is not known although accepted by many as occurring due to repetitive traction of the peroneus brevis tendon at the site of its attachment. 

It can be more frequently seen in children engaged in sporting activities which require running and jumping.

Radiographic features

Plain radiograph

• obliquely oriented small bony fleck at the base of the 5th metatarsal which is best seen on oblique radiograph
• apophyseal irregularity

MRI

Usually not considered essential for the diagnosis. But if performed may show:

• T2/STIR: high signal intensity around base of 5^th metatarsal due to bone marrow edema ⁶

History and etymology

First described by Hans Iselin (1878-1953) ⁸ a German surgeon working in Basel, Switzerland, in 1912 ^4,5.

Differential diagnosis

Imaging differential considerations include

• normal apophysis
• os vesalianum pedis
• os peroneum
• stress fracture of the 5^th metatarsal
• avulsion fracture of the 5^th metatarsal styloid - pseudo-Jones fracture
• Jones fracture