Fifth Metatarsal Apophysitis 

Last updated: February 8, 2026Reviewed date: February 8, 2026Reading time: 4 min read
Patient Tools

Read, save, and share this guide

Use these quick tools to make this medical article easier to read, print, save, or share with a family member.

Article Summary

Fifth Metatarsal Apophysitis is painful irritation and inflammation of the apophysis (growth plate) at the base of the 5th metatarsal (foot bone), where one of the calf muscles inserts. In a child, the bones grow from areas called growth plates. The apophysis of the proximal 5th metatarsal (plural apophyses) lies laterally and is oriented longitudinally parallel to the shaft. Apophysis of the fifth metatarsal base appears on plain...

Key Takeaways

  • This article explains Other Names in simple medical language.
  • This article explains Pathophysiology in simple medical language.
  • This article explains Causes in simple medical language.
  • This article explains Risk Factors in simple medical language.
Educational health guideWritten for patient understanding and clinical awareness.
Reviewed content workflowUse writer and reviewer profiles for stronger trust.
Emergency safety firstUrgent warning signs are highlighted below.

Seek urgent medical care if you notice

These warning signs are general safety guidance. Local emergency numbers and clinical judgment should always come first.

  • Severe symptoms, breathing difficulty, fainting, confusion, or rapidly worsening illness.
  • New weakness, severe pain, high fever, or symptoms after a serious injury.
  • Any symptom that feels urgent, unusual, or unsafe for the patient.
1

Emergency now

Use emergency care for severe, sudden, rapidly worsening, or life-threatening symptoms.

2

See a doctor

Book a professional medical evaluation if symptoms persist, worsen, recur often, affect daily activities, or occur in a high-risk patient.

3

Learn safely

Use this article to understand possible causes, tests, treatment options, prevention, and questions to ask your clinician.

Fifth Metatarsal Apophysitis is painful irritation and infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।" data-rx-term="inflammation" data-rx-definition="Inflammation is the body’s response to injury, infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।">inflammation of the apophysis (growth plate) at the base of the 5th metatarsal (foot bone), where one of the calf muscles inserts. In a child, the bones grow from areas called growth plates. The apophysis of the proximal 5th metatarsal (plural apophyses) lies laterally and is oriented longitudinally parallel to the shaft. Apophysis of the fifth metatarsal base appears on plain radiographs at age 12 for boys and 10 for girls. Through an open incision, surgeons can return your fractured bone into the normal position and fix your fifth metatarsal bone with what is called an intramedullary screw. This screw is run through the marrow cavity in the center of your fifth metatarsal. Most patients can go home the same day after surgery.

Other Names

  • Iselin’s Disease
  • 5th Metatarsal Apophysitis
  • Fifth Metatarsal Apophysitis

 

Pathophysiology

  • General
    • Is a benign, painful traction apophysitis or osteochondrosis of the apophysis of the 5th metatarsal tuberosity
    • Exclusive to skeletally immature patients
    • Generally considered a self-limited disorder
  • Often confused for
    • Fracture of the base of the fifth metatarsal

Causes

  • Peroneus Brevis Tendon (PB Tendon)
    • Attaches to the tuberosity of the fifth metatarsal (apophysis)
    • Caused by repetitive microtrauma at the site of attachment
    • Can result in partial/complete avulsion of the apophysis and infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।" data-rx-term="inflammation" data-rx-definition="Inflammation is the body’s response to injury, infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।">inflammation
  • Associated with athletics where repetitive motion occurs
    • Especially sports that stress the forefoot such as dance, ballet, skating
    • Sports that require jumping and running
  • Fifth Metatarsal
    • The secondary ossification center appears as a small fleck oriented slightly oblique to the metatarsal shaft
    • Located on the lateral aspect of the tuberosity of the fifth metatarsal
    • Peroneus brevis inserts over this apophysis before skeletal maturity

Risk Factors

  • Sports
    • Dance
    • Ballet
    • Roller skating

diagnosis: Differential diagnosis is a list of possible conditions that may explain symptoms. সহজ বাংলা: একই লক্ষণের সম্ভাব্য রোগের তালিকা।" data-rx-term="differential diagnosis" data-rx-definition="Differential diagnosis is a list of possible conditions that may explain symptoms. সহজ বাংলা: একই লক্ষণের সম্ভাব্য রোগের তালিকা।">Differential Diagnosis

  • Jones Fracture
  • 5th Metatarsal Avulsion Fracture
  • 5th Metatarsal Stress Fracture
  • Os Vesalianum

diagnosis: Differential diagnosis is a list of possible conditions that may explain symptoms. সহজ বাংলা: একই লক্ষণের সম্ভাব্য রোগের তালিকা।" data-rx-term="differential diagnosis" data-rx-definition="Differential diagnosis is a list of possible conditions that may explain symptoms. সহজ বাংলা: একই লক্ষণের সম্ভাব্য রোগের তালিকা।">Differential Diagnosis Foot Pain

  • Fractures & Osseous Disease
    • Traumatic/ Acute
      • Talus Fracture
      • Calcaneus Fracture
      • Traumatic Navicular Fracture
      • Cuboid Fracture
      • Cuneiform Fracture
      • Metatarsal Fracture
        • Fifth Metatarsal Fracture
      • Toe Fracture
      • Hallux Sesamoid Fracture
    • Stress Fractures
      • Navicular Stress Fracture
      • Metatarsal Stress Fracture
    • Other Osseous
      • Tarsal Coalition
      • Accessory Navicular Syndrome
  • Dislocations & Subluxations
    • Toe Dislocation
    • Lisfranc Injury
    • Chopart Complex Injury
    • Cuboid Syndrome
  • Muscle and Tendon Injuries
    • Posterior Tibial Tendon Dysfunction
    • Peroneal Tendonitis
    • Tibialis Anterior Tendinopathy
    • Flexor Hallucis Longus Tendinopathy
  • Ligament Injuries
    • Plantar Fasciopathy (Plantar Fasciitis)
    • Turf Toe
    • Plantar Plate Tear
    • Spring Ligament Injury
  • Neuropathies
    • Mortons Neuroma
    • Tarsal Tunnel Syndrome
    • Joggers Foot (Medial Plantar Nerve)
    • Baxters Neuropathy (Lateral Plantar Nerve)
  • Arthropathies
    • Hallux Rigidus (1st MTPJ OA)
    • Gout
  • Toenail
    • Subungual Hematoma
    • Subungual Exostosis
    • Nail Bed Laceration
    • Onychocryptosis (Ingrown Toenail)
    • Onychodystrophy
    • Paronychia
    • Onychomycosis
  • Pediatrics
    • Fifth Metatarsal Apophysitis (Iselin’s Disease)
    • Calcaneal Apophysitis (Sever’s Disease)
    • Freibergs Disease (Avascular Necrosis of the Metatarsal Head)

Diagnosis

  • History
    • The athlete is typically 10 to 16 years old
    • Insidious onset with no history of trauma
    • A most common symptom is a pain in the lateral part of the foot or around the base of the fifth metatarsal
    • Worse with activity and improves with rest
    • May have difficulty or pain with wearing shoes
    • Patients may have 3-6 months of symptoms before presentation
  • Physical Exam: Physical Exam Foot
    • Swelling and erythema over the base of 5th metatarsal
    • Tenderness over the base of 5th metatarsal tuberosity
    • Pain with resisted eversion and extreme plantarflexion/inversion
    • On gait exam, may favor the medial side of the foot
  • Special Tests
Oblique foot radiograph showing elevation, fragmentation and sclerosis of the apophysis with overlying soft tissue swelling consistent with 5th metatarsal apophysitis.[3]

Radiographs

  • Standard Radiographs Foot
    • Apophysis saw on oblique view
  • Findings
    • Fragmentation
    • Widening or enlargement of the apophysis
    • Cystic changes around the apophysis
    • Widened chondro-osseous junction
  • Normal apophysis
    • Fleck of bone parallel to the long axis of 5th metatarsal (≠ avulsion fracture),
    • Visible in girls (9-11), boys (11-14)

MRI

  • Findings
    • Edema over the unfused apophysis
    • Mild to moderate marrow edema in the adjacent fifth metatarsal

Bone Scintigraphy

  • Generally not indicated or performed
  • Findings
    • Increased uptake over the apophysis

Treatment

Nonoperative

  • Indications
    • All cases
  • Activity modification
    • Discontinue offending activity
    • Rest from sports
  • Immobilization/ weight-bearing status
    • Cast immobilization if persistent pain despite other non-surgical management
    • May require crutches
  • Physical Therapy
    • Can begin after pain, tenderness is completely resolved
    • Stretching of peroneal and calf muscles
  • Ice Therapy
  • Foot Orthosis
    • A small lateral elevation or a lateral wedge ensures reduced stress on the peroneal muscles during daily activities
  • Prevention
    • Maintain calf, peroneal, and ankle flexibility and strength
    • Check shoe size during rapid periods of growth

Operative

  • Indications
    • Persistent pain despite exhaustive nonoperative treatment
    • Nonunion over the apophysis
    • Persistent widening of radiolucent lines after 3-6 months
  • Operative
    • Surgical excision
Patient safety assistant

Check your symptom safely

Hi, I am RX Symptom Navigator. I can help you understand what to read next and what warning signs need care.
Warning: Do not use this in emergencies, pregnancy, severe illness, or as a substitute for a doctor. For children or teens, use with a parent/guardian and clinician.
A rural-friendly guide: warning signs, when to see a doctor, related articles, tests to discuss, and OTC safety education.
1 Symptom 2 Severity 3 Safe guidance
First safety question

Is there chest pain, breathing trouble, fainting, confusion, severe bleeding, stroke-like weakness, severe injury, or pregnancy danger sign?

Choose quickly

Browse by body area
Start here: Write or select a symptom. The guide will show warning signs, doctor guidance, diagnostic tests to discuss, OTC safety education, and related RX articles.

Important: This tool is educational only. It cannot diagnose, treat, or replace a doctor. OTC information is not a prescription. In an emergency, contact local emergency services or go to the nearest hospital.

Frequently Asked Questions

Is this article a replacement for a doctor?

No. It is educational content only. Patients should consult a qualified clinician for diagnosis and treatment.

When should I seek urgent care?

Seek urgent care for severe symptoms, rapidly worsening condition, breathing difficulty, severe pain, neurological changes, or any emergency warning sign.

References

Add references, clinical guidelines, textbooks, journal articles, or trusted medical sources here. You can edit this area from the RX Article Professional Blocks panel.

More from this topic
  1. Congenital Bilateral Absence of Vas Deferens

    Congenital? bilateral absence of vas deferens, often shortened to CBAVD, is a condition present from birth in which both vas deferens tubes do not develop normally....

    March 10, 2026 • Rx Autoimmune, Genetic and Rare Diseases (A - Z)
  2. Congenital Autosomal Recessive Small-Platelet Thrombocytopenia

    Congenital? autosomal recessive small-platelet? thrombocytopenia? is a very rare inherited blood disorder. “Congenital?” means a person is born with it. “Autosomal recessive” means the child usually...

    March 10, 2026 • Rx Blood, Metabolism, and Infectious Diseases (A - Z)
  3. Congenital Anosmia

    Congenital? anosmia means a person is born with no sense of smell. The smell loss is present from birth and usually lasts for life. In some...

    March 9, 2026 • Rx ENT, Oral and Dental Health (A - Z)
  4. Cone-Rod Dystrophy Type 6

    Cone-rod dystrophy type 6 (often written as CORD6) is a rare eye disease that slowly damages the light-sensing cells (cones and rods) in the retina, the...

    March 4, 2026 • Rx Eye & Vision Care (A - Z)
  5. Cone-Rod Dystrophy Type 5

    Cone-rod dystrophy type 5 (often written as CORD5) is a very rare, inherited eye disease that slowly damages the light-sensing cells in the back of the...

    March 4, 2026 • Rx Autoimmune, Genetic and Rare Diseases (A - Z)
  6. Jackson-Barr Syndrome

    Jackson-Barr syndrome is a very rare genetic condition that affects hearing, the eyelids, the skeleton (bones and joints), and some parts of the skin, hair, and...

    March 2, 2026 • Rx Autoimmune, Genetic and Rare Diseases (A - Z)
  7. Conductive Hearing Loss-Ptosis-Skeletal Anomalies Syndrome

    Conductive hearing loss-ptosis-skeletal anomalies syndrome is a very rare genetic condition. In this syndrome, the tiny passages and bones in the outer and middle ear do...

    March 2, 2026 • Rx ENT, Oral and Dental Health (A - Z)
  8. Conductive Deafness–Ptosis–Skeletal Anomalies Syndrome

    Conductive deafness–ptosis–skeletal anomalies syndrome is a very rare genetic syndrome where a person is born with a block in the sound-path of the ear (conductive hearing...

    March 2, 2026 • Rx Autoimmune, Genetic and Rare Diseases (A - Z)
  9. Varus Elbow Deformity

    Varus elbow deformity means that the elbow is bent inward, so the forearm points toward the middle of the body instead of slightly away from it...

    February 11, 2026 • Degenerative Bones, Joints, and Spine Care (A - Z)
  10. Sorsby Syndrome

    Sorsby syndrome is a very rare genetic disease that affects both the eyes and the fingers and toes from birth. The main problems are a special...

    February 10, 2026 • Rx Autoimmune, Genetic and Rare Diseases (A - Z)