Muller Weiss Disease

Imaging of Müller-Weiss Disease

“…Lateral shifting of the talar head is followed by plantar collapse and calcaneus inversion, thus causing a paradoxical pes planus varus, characteristic of MWD. 3 If compressive forces were homogeneously distributed across the entire tarsal navicular, the chondral anlage would cope with them, so no deformity would develop, except for an eventual symmetrical flattening in its anteroposterior width. This could possibly occur in Köhler's disease, a self-limited benign condition, also known as naviculare pedis retardatum 16 ( Fig.…”

“…Three different pathogenic pathways may be noticed in MWD patients: the “epidemic/environmental/nutritional” cases; the “non-epidemic” in athletes who practiced intensive training during childhood (“too much, too soon” for the navicular) and had a short first ray affecting their navicular bones (even though they had the right ossification schedule); and an adult-onset MWD known as “Müllerweissoid feet” that shares the same pathomechanics with conventional MWD. 1 3 Müllerweissoid feet usually present with a short first metatarsal and subtalar varus, but the navicular usually shows subtle morphological changes with no evident dysplasia. Subtalar varus eliminates subtalar cushioning and midfoot compensation in the sagittal plane.…”

“…Subtalar varus deformity is almost inherent to MWD. 3 Many direct and indirect signs of hindfoot varus and talonavicular alterations may be observed in plain weight-bearing radiographs of both feet. 1 21…”

“…2 MWD is frequently reported as an uncommon finding in orthopaedic daily practice, but we believe it is much more common than thought because many patients are undiagnosed or misdiagnosed. 3 Failure to identify patients who present with paradoxical flatfeet (with hindfoot varus instead of conventional valgus) may lead to an incorrect diagnosis and management. Delayed ossification of the tarsal navicular in young patients with a short first metatarsal may allow compressive forces to act on the lateral aspect of the bone, inducing early dysplasia with flattening and fragmentation of the lateral third of the navicular.…”

“…Conservative treatment with the use of insoles with medial arch support and a lateral heel wedge to reduce supination of the heel is effective in most patients. 3 Those who fail to respond to insoles and experience severe pain and disability are candidates for surgery. Although the classic surgical treatment for MWD consisted of selective arthrodesis to cover arthritis of the affected joints, the modern concept of joint-preserving surgery for asymmetric arthritis, together with the recognition of subtalar varus deformity in MWD, has changed the approach to surgical treatment.…”