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8
Iselin's Apophysitis: The Unappreciated Osteochondrosis of the Foot

Saturday, October 11, 2014
Indigo Ballroom C (Hilton San Diego Bayfront)
Jillian E Sylvester, M.D., Penn State College of Medicine, Hershey, PA and William Hennrikus, M.D, Orthopaedic Surgery, Penn State/Milton S Hershey Medical Center, Hershey, PA

Purpose:   Iselin's Apophysitis is a traction-apophysitis at the proximal apophysis of the tuberosity of the fifth metatarsal.  The apophysis appears in females at age 10 and in males at age 12 and fuses with the shaft of the fifth metatarsal approximately two years later.  Iselin's is common in adolescents engaged in soccer, basketball, gymnastics, and dance.  We aim to examine the presentations and outcomes of patients treated for Iselin's Apophysitis. 

Methods:   Retrospective review of patients with Iselin's Apophysitis between January 2008 and December 2013.  Patients reporting pain at the base of the 5th metatarsal with radiographic evidence of Iselin's were included. All radiographs were assessed and records were evaluated for patient demographics, treatment modalities, and time to return to play (RTP).

Results: Twenty-seven patients (12 males,15 females) were found to have Iselin's Apophysitis.  Six were initially given a diagnosis other than Iselin's, including five with metatarsal fracture and one with peroneal tendonitis.

Ave. age of presentation was 10 years for females and 13 for males.  All patients played sports, including soccer (4) and football (4), basketball (5), gymnastics/dance (5).  Fourteen patients played more than one sport. Ten (37%) presented with a chronic complaint and 17 (63%) reported an acute trauma. Three patients (11%) had severe pain and were unable to walk or play sports.  Sixteen (60%) reported moderate pain and were able to walk but unable to play sports.  Eight (30%) had mild pain, but could continue their activities. 

The three who presented to clinic unable to bear weight were treated with CAM walker boot. Treatments for the remaining 24 patients included rest, changes in footwear, CAM boot, post-op shoe, and heel cups.  Ave treatment length was 24 days and RTP was 38 days.  We report three re-injuries and no non-unions.

Conclusion: To our knowledge, this is the largest case series of Iselin's Apophysitis in literature.  Although Iselin's is considered rare in previous literature, it is probably more common than previously thought.  One third of cases were chronic and two-thirds were acute.  All cases healed, despite a variety of conservative treatment methods. Lastly, in 22% of cases, the injury was initially misdiagnosed as a fracture or tendonitis. 

Treatment Modality

Number Treated

Average Length of Treatment (days)

Average Time to RTP

(days)

Non-Union

Reinjuries

RICE

2

14

14

0

0

Heel Cups + RICE

1

14

Unknown

0

Unknown

Bigger shoe box + RICE

2

21

28

0

0

No Treatment

1

0

Unknown

0

Unknown

Hard-soled shoe

5

24.5

32

0

2

CAM Boot

17

23.88 in CAM,

28.4 rest

38

0

1 (at 2 weeks),

Cast

1

21

28

0

0

Table 1:  All Primary and Secondary Treatment Modalities and associated RTP:  RICE=Rest, Ice, Compression, Elevation;


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