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Iselin disease is a painful inflammation of the growth plate at the base of the 5th toe on the outside of the foot. It's most often caused by repetitive pressure and tension on this growth plate. The growth plate is made up of cartilage which is softer and more vulnerable to injury than bone that is more developed. This disease is commonly seen in children who participate in sports and are between 9-14 years of age. That's the time when the growth plate has not fully fused, leaving young athletes more vulnerable to this condition. Girls can have the condition up to age 12 and boys up to age 14.
This disease is similar to Sever's disease but occurs in a different location on the foot. In Sever's disease the heel is affected.
Who's at Risk?
Children most at risk are those who are:
- active in soccer, gymnastics, basketball, and dance since running and jumping can put a lot of pressure on the ball of the foot.
- wearing unsupportive footwear.
And who have:
- faulty foot mechanics such as flat feet or a high-arched foot.
- equinus or tight calf muscles can also increase a child's risk as this condition increases the tension on the growth plate.
Signs and Symptoms
Typical signs and symptoms of Iselin's disease are:
- pain along the outer edge of the foot which gets worse with activity and improves with rest
- limping on the affected side
- walking on the inside of the affected foot
- skin over the symptomatic area may be swollen, red, painful, or warm
Diagnosis
Your podiatrist will diagnose Iselin's disease after a complete history and physical examination. This may include assessing range of motion in foot joints, gait analysis, foot type, muscle testing, and footwear examination.
Treatment
Reduce inflammation in Acute Stage
Initially treatment focuses on reducing the inflammation and relieving the pressure on the growth plate. Children need to stop their physical activity to start the healing process. Ice should be applied 10 to 15 minutes every 2 to 3 hours to reduce the pain and swelling. Anti-inflammatory medications can also help during this early treatment stage.
Align Feet Properly With Inserts or Orthotics
After the inflammation has decreased, your podiatrist will very likely recommend orthotics if the child has abnormal foot mechanics. Depending on the level of abnormality he/she may recommend over-the-counter orthotics, a pre-fab orthotic for children whose feet are still growing called Little Steps, or a custom orthotic for older children.
Resolve Calf Tightness Through Stretching
Stretching can help relieve the pressure on the growth plate. This will be particularly important for patients with tight calf muscles. I recommend my patients use an Achilles splint during the day to get a sufficient stretch.
Use of a Walking Boot
When the pain and inflammation aren't resolved easily a walking boot may be required for a specific period of time.
Purchase Supportive and Appropriate Shoes
Before the youth athlete begins active play, a supportive and appropriate shoe should be purchased. The following guidelines will assist in buying a shoe to prevent reoccurence of Iselin's disease.
Buy shoes:
- from a reputable athletic shoe store - REI, Super Jock 'N Jill, Brooks, or Soccer West are some of our recommendations
- specifically designed for the sport your youth athlete engages in
- that bend at the toe not in the center, are difficult to twist when you try to wring them out like a rag, and have a stiff heel counter that you can’t move easily.
