Traction apophysitis of the fifth metatarsal base with an avulsion fracture

Case contributed by Dr Samir Benoudina

Presentation

Pain over the lateral border of the foot for a few months. Exacerbated by a recent twisting injury during a football game.

Patient Data

Age: 11 years
Gender: Male

A bony fragment lateral to the base of the fifth metatarsal oriented longitudinally; with a widening of chondro-osseous junction, fragmentation: traction apophysitis of the fifth metatarsal base.

Transverse lucency at the base of the fifth metatarsal: avulsion fracture.

Blue: Iselin disease

Red: Avulsion fracture

Case Discussion

Iselin's disease is a traction apophysitis of the tuberosity of the fifth metatarsal. It occurs in physically active boys and girls between the ages of 9 and 14. It is caused by repetitive traction of peroneus brevis tendon at the site of its attachment. Clinically, there is a lateral midfoot pain aggravated by sports activities.

Differential diagnosis includes:

  • Normal apophysis: painless longitudinally oriented apophysis without fragmentation or widening of chondro-osseous junction.
  • Os vesalianum.
  • The base of 5th metatarsal fractures: A fracture tends to be oriented transversally; whereas a growth plate has always a longitudinal orientation.

In this case, Iselin disease and an avulsion fracture are present simultaneously.

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