Fifth Metatarsal Apophysitis 

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

For severe symptoms, danger signs, pregnancy, child illness, or sudden worsening, seek urgent medical care.

বাংলা রোগী নোট এখনো যোগ করা হয়নি। পোস্ট এডিটরে “RX Bangla Patient Mode” বক্স থেকে সহজ বাংলা সারাংশ যোগ করুন।

এই তথ্য শিক্ষা ও সচেতনতার জন্য। এটি ডাক্তারি পরীক্ষা, রোগ নির্ণয় বা প্রেসক্রিপশনের বিকল্প নয়।

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.
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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.

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Definition

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
Doctor visit helper

Prepare before seeing a doctor

A simple rural-patient checklist to help you explain symptoms clearly, ask better questions, and avoid unsafe self-treatment.

Safety note: This is not a prescription or diagnosis. For severe symptoms, pregnancy danger signs, children with serious illness, chest pain, breathing difficulty, stroke-like weakness, or major injury, seek urgent care.

Which doctor may help?

Start with a registered doctor or the nearest qualified health center.

What to tell the doctor

  • Write when the problem started and how it changed.
  • Bring old prescriptions, investigation reports, and current medicines.
  • Write allergies, pregnancy status, diabetes, kidney/liver disease, and major past illnesses.
  • Bring one family member if the patient is weak, elderly, confused, or a child.

Questions to ask

  • What is the most likely cause of my symptoms?
  • Which danger signs mean I should go to hospital quickly?
  • Which tests are necessary now, and which can wait?
  • How should I take medicines safely and what side effects should I watch for?
  • When should I come for follow-up?

Tests to discuss

  • Vital signs: temperature, pulse, blood pressure, oxygen saturation
  • Basic physical examination by a clinician
  • CBC, urine test, blood sugar, or imaging only when clinically needed

Avoid these mistakes

  • Do not use antibiotics, steroid tablets/injections, or strong painkillers without proper medical advice.
  • Do not hide pregnancy, kidney disease, ulcer, allergy, or blood thinner use.
  • Do not delay emergency care when danger signs are present.

Medicine safety and first-aid guide

This section is for patient education only. It does not replace a doctor, pharmacist, or emergency care.

Safe first steps

  • Avoid heavy lifting, sudden bending, and prolonged bed rest.
  • Use comfortable posture and gentle movement as tolerated.
  • Discuss physiotherapy, X-ray, or MRI only when clinically needed.

OTC medicine safety

  • For mild back pain, pain-relief medicine may be discussed with a doctor or pharmacist.
  • Avoid repeated painkiller use if you have kidney disease, stomach ulcer, uncontrolled blood pressure, or are taking blood thinners.

Avoid these mistakes

  • Do not start antibiotics without a proper medical decision.
  • Do not use steroid tablets or injections casually for quick relief.
  • Do not delay emergency care because of home remedies.

Get urgent help if

  • Back pain with leg weakness, numbness around private area, loss of urine/stool control, fever, cancer history, or major injury needs urgent care.
Medicine names, dose, and timing must be decided by a qualified clinician or pharmacist after checking age, pregnancy, allergy, other diseases, and current medicines.

For rural patients and family caregivers

Patient health record and symptom diary

Write your symptoms, medicines already taken, test results, and questions before visiting a doctor. This note stays on your device unless you print or copy it.

Doctor to discuss: Doctor / qualified healthcare provider
Tests to discuss with doctor
  • Basic vital signs: temperature, pulse, blood pressure, oxygen level if needed
  • Relevant blood, urine, imaging, or specialist tests only after clinical assessment
Questions to ask
  • What is the most likely cause of my symptoms?
  • Which warning signs mean I should go to emergency care?
  • Which tests are really needed now?
  • Which medicines are safe for my age, pregnancy status, allergy, kidney/liver/stomach condition, and current medicines?

Emergency warning signs such as chest pain, severe breathing difficulty, sudden weakness, confusion, severe dehydration, major injury, or loss of bladder/bowel control need urgent medical care. Do not wait for online information.

Safe pathway to proper treatment

Care roadmap for: Fifth Metatarsal Apophysitis 

Use this simple roadmap to understand the next safe steps. It is educational and does not replace examination by a doctor.

Go to emergency care if you notice:
  • Severe or rapidly worsening symptoms
  • Breathing difficulty, chest pain, fainting, confusion, severe weakness, major injury, or severe dehydration
Doctor / service to discuss: Qualified healthcare provider; specialist depends on symptoms and examination.
  1. Step 1

    Check danger signs first

    If danger signs are present, seek emergency care and do not wait for online information.

  2. Step 2

    Record the symptom story

    Write when symptoms started, severity, medicines already taken, allergies, pregnancy status, and test results.

  3. Step 3

    Visit a qualified clinician

    A doctor, nurse, or qualified healthcare provider can examine you and decide which tests or treatment are needed.

  4. Step 4

    Do only useful tests

    Do tests after clinical assessment. Avoid unnecessary tests, random antibiotics, or repeated medicines without diagnosis.

  5. Step 5

    Follow up and return early if worse

    If symptoms worsen, new warning signs appear, or treatment is not helping, return for review quickly.

Rural patient practical tips
  • Take a written symptom diary and all previous prescriptions/test reports.
  • Do not hide medicines already taken, even herbal or over-the-counter medicines.
  • Ask which warning signs mean urgent referral to hospital.

This roadmap is for education. A real diagnosis and treatment plan requires history, examination, and clinical judgment.

RX Patient Help

Ask a health question safely

Write your symptom story. A health professional or site editor can review it before any answer is prepared. This box is not for emergency care.

Emergency first: Severe chest pain, breathing trouble, unconsciousness, stroke signs, severe injury, heavy bleeding, or rapidly worsening symptoms need urgent local medical care now.

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

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