Welcome to the Podiatry Arena forums, for communication between foot health professionals about podiatry and related topics.
You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members (PM), upload content, view attachments, receive a weekly email update of new discussions, earn CPD points and access many other special features. Registered users do not get displayed the advertisments in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!
If you have any problems with the registration process or your account login, please contact contact us.
Does anybody have any useful articles/references regarding Iselin's disease? I have an 11 year old patient that I think has this, but cannot find much literature to help me.
She has had right lateral foot pain for approximately 4 months and has a minimally enlarged styloid process on the affected foot, with pain on prolonged activity. She is a very sporty girl (Netball, Hockey, Lacrosse etc) with particularly unstable subtalar/midtarsal areas but wears ballet-style shoes with a kitten heel (half inch) to school
The styloid process is painful on palpation, with some mild tenderness around the lateral malleolus/peroneus brevis tendon.
My instinct is to deal with the instability/footwear issues and await resolution. Does anyone have any thoughts/ideas? GP reluctant to order x-ray at this stage. Incidentally, the right foot is approximately 1 size smaller than the left
Does anybody have any useful articles/references regarding Iselin's disease? I have an 11 year old patient that I think has this, but cannot find much literature to help me.
She has had right lateral foot pain for approximately 4 months and has a minimally enlarged styloid process on the affected foot, with pain on prolonged activity. She is a very sporty girl (Netball, Hockey, Lacrosse etc) with particularly unstable subtalar/midtarsal areas but wears ballet-style shoes with a kitten heel (half inch) to school
The styloid process is painful on palpation, with some mild tenderness around the lateral malleolus/peroneus brevis tendon.
My instinct is to deal with the instability/footwear issues and await resolution. Does anyone have any thoughts/ideas? GP reluctant to order x-ray at this stage. Incidentally, the right foot is approximately 1 size smaller than the left
Any advice gratefully received.
Ella
Ella:
I don't know if you can properly diagnosis Iselin's disease without an x-ray, but it certainly seems a likely possibility. Regardless of the proper radiographic diagnosis, you may consider that this young lady has increased peroneus brevis contractile activity due to a laterally deviated subtalar joint (STJ) axis. The peroneus brevis muscle will be especially active in the side-to-side sports she is involved with. Put a 3-6 mm valgus in-shoe wedge on her shoe insole with adhesive felt or other similar material as illustrated below. This wedge will increase the external STJ pronation moments that should then decrease the contractile activity in the peroneus brevis muscle during her weightbearing activities (Kirby KA: Subtalar joint axis location and rotational equilibrium theory of foot function. JAPMA, 91:465-488, 2001). Have her use this "temporary orthosis" in all her shoes and give her specific shoe recommendations that this insole will work with. When the valgus-wedged insole is combined with daily icing therapy, I would expect her pain to be at least 50-75% better within two weeks. Please keep us all informed of her progress for the education of everyone following along.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Information on Iselin's is hard to come by. This is the extent of the lecture notes I give the students:
Quote:
Iselin’s disease:
Osteochondrosis of the fifth metatarsal base at attachment of peroneus brevis; need to differentiate from a stress fracture, os vesaleanum or fracture; pain increases on tension on peroneus brevis
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
Last edited by Craig Payne : 18th February 2008 at 01:48 PM.
I have also found that the good old firm foot taping can be of benefit to these patients.
Showing the mother/father how to tape appropriately means they can be supported for their activity time and then removing for night time/times of in-activity.
Thanks for your advice - trouble is, here in UK (the NHS) I can't just order x-rays myself. I have to involve the GP and unfortunately he doesn't want to get any at the moment. We are working on those in authority to allow us to order x-rays ourselves, but it's in a long and frustrating bureaucratic process involving public funding issues etc ! Hopefully shouldn't be too much longer!
I saw the same little girl again yesterday and am pleased to report that she is feeling much better. Her symptoms have almost completely resolved with Kevin's insole design, as advised in an earlier posting.
Thank's for your advice Kevin -
I will, of course, be monitoring her until complete resolution and then may to need to address her instability issues.
I saw the same little girl again yesterday and am pleased to report that she is feeling much better. Her symptoms have almost completely resolved with Kevin's insole design, as advised in an earlier posting.
Thank's for your advice Kevin -
I will, of course, be monitoring her until complete resolution and then may to need to address her instability issues.
Ella:
Thanks for the update on your patient. I'm glad the young lady is able to be more comfortable in her sports now.
This is a great example demonstrating that with good biomechanical theory, even simple insole modifications may be used to effectively heal seemingly difficult-to-treat pathology.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Iselin's Disease
Re: Iselin's Disease
Linear Mode
