Imaging of Müller-Weiss Disease

Abstract

Müller-Weiss disease (MWD) is the result of a dysplasia of the tarsal navicular bone. Over the adult years, the dysplastic bone leads to the development of an asymmetric talonavicular arthritis with the talar head shifting laterally and plantarly, thus driving the subtalar joint into varus. From a diagnostic point of view, the condition may be difficult to differentiate from an avascular necrosis or even a stress fracture of the navicular, but fragmentation is the result of a mechanical impairment rather than a biological dysfunction.Standardized weight-bearing radiographs (anteroposterior and lateral views) of both feet are usually enough to diagnose MWD. Other imaging modalities such as multi-detector computed tomography and magnetic resonance imaging in early cases for the differential diagnosis can add additional details on the amount of cartilage affected, bone stock, fragmentation, and associated soft tissue injuries. Failure to identify patients with paradoxical flatfeet varus may lead to an incorrect diagnosis and management. Conservative treatment with the use of rigid insoles is effective in most patients. A calcaneal osteotomy seems to be a satisfactory treatment for patients who fail to respond to conservative measures and a good alternative to the different types of peri-navicular fusions. Weight-bearing radiographs are also useful to identify postoperative changes.

Müller-Weiss Disease: Midfoot Arthrodesis in Reduction vs Malreduction

“…Moreover, regression analysis revealed a positive correlation between midfoot abduction and postoperative pain after midfoot arthrodesis (P = .007). These results are consistent with those of Harnroongroj et al 14 When reviewing previous MWD literature and scrutinizing their illustrations, we found that most researchers focused more on restoring the medial longitudinal arch, 4,10,17,19 medial column length, 10,31 hindfoot alignment, 5,18,24 and perinavicular arthrodesis through malreduction, 3,11,13,20 while overlooking midfoot abduction. The clinical AOFAS and VAS scores in the reduction group were better than those in the malreduction group (all P < .05), implying that the pain was caused not only by the degeneration of the involved joints, but also by impaired biomechanics, such as the midfoot abduction deformity represented by the TMT1dp, leading to an uneven load distribution on the foot (Figures 1, 5, and 6).…”

“…Müller-Weiss disease (MWD) is characterized by progressive foot deformity and medial navicular subluxation. Contrary to the findings of previous studies, 5,10,22 MWD is not as uncommon, particularly according to foot and ankle surgeons. MWD is more prevalent among women and often occurs bilaterally, with its primary symptom being chronic pain in the peri-navicular joints during weightbearing.…”

Enfermedad de Muller Weiss: A referencia de un caso clínico

“…El diagnóstico se realiza mediante una radiografía simple de pie con carga, observando la deformidad en varo del retropié, escafoides en forma de "coma" por la constante compresión, [7][8] divergencia astrágalo -calcáneo disminuida, inex minus que hace referencia al primer metatarsiano más corto de lo habitual.…”