Müller-Weiss Disease: The Descriptive Factors of Failure Conservative Treatment

Harnroongroj, Thos; Tharmviboonsri, Theerawoot; Chuckpaiwong, Bavornrit

doi:10.1177/10711007211002826

Cited by 10 publications

(11 citation statements)

References 19 publications

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“…Patients often suffer chronic and progressive midfoot and hindfoot pain. Surgical management may be indicated and considered if symptoms persist after an adequate trial of initial conservative treatment [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Midterm outcomes of midfoot and hindfoot arthrodesis with strut allograft for Müller–Weiss disease

Lee

Yang

et al. 2022

BMC Musculoskelet Disord

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Background Müller–Weiss disease (MWD), a rare dysplastic disorder of the foot, is characterized by deformity, sclerosis, and fragmentation of the lateral part of navicular bone. Arthrodesis is the mainstay treatment for MWD. Generally, arthrodesis can be achieved through internal fixation with metallic implants, and morselized chip bone may be packed into the gap for better bone union. However, with this procedure, the original foot size is not maintained and support for the foot arch is not provided. Sequela of short foot, or flatfoot is commonly observed even though these complications of surgery had not been reported with cases of MWD treated by arthrodesis. Herein, we present a retrospective analysis of treating MWD through midfoot and hindfoot arthrodesis combined with strut allograft. Methods From August 2006 to June 2019, 20 patients with MWD (mean age, 59.6 years; range, 40–80 years) underwent midfoot and hindfoot arthrodesis with strut bone allograft and were followed for at least 24 months. The patients were able to ambulate and participate in rehabilitation programs 3 months postoperatively. Results The used four radiographic parameters (Meary’s angle in anteroposterior and lateral view, talonavicular coverage angle, calcaneal pitch) demonstrated significant differences (P < .05) preoperatively and postoperatively, but those between the postoperative values and the values at the last follow-up session did not, indicating that strut allograft was able to maintain normal alignment. The mean American Orthopaedic Foot & Ankle Society Ankle-Hindfoot scores at 2 years postoperatively revealed significant improvement from baseline, from 60.2 to 84.2 (P < .05). The 12-item Short Form Health Survey scores also improved significantly (P < .05). All patients reported substantial pain relief and exhibited improved functional outcomes and gait patterns. Conclusions For advanced-stage MWD, arthrodesis with a precisely shaped, size-matched strut allograft provided strong support for biomechanical alignment and enhanced functional performance.

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Section: Introductionmentioning

confidence: 99%

Midterm outcomes of midfoot and hindfoot arthrodesis with strut allograft for Müller–Weiss disease

Lee

Yang

et al. 2022

BMC Musculoskelet Disord

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“…The success rate of conservative treatment in MWD has been previously reported. [17][18][19] Harnroongroj et al studied the 5-year survivorship of conservative treatment in 32 patients with Maceira stage 3 MWD. The endpoint of survivorship was defined as the conversion to surgical treatment due to pain disturbing activities of daily living.…”

Section: Nonoperative Treatmentsmentioning

confidence: 99%

“…17 The study determined that factors associated with failure of conservative treatment included an abducted midfoot (radiographic Meary angle more than 13°) and radiographic talonavicular arthritis. 19 Patients presenting with these descriptive factors should be informed about the increased likelihood of surgery. 19 There are no definite guidelines for the timeframe of follow-up for MWD patients treated conservatively.…”

Section: Nonoperative Treatmentsmentioning

confidence: 99%

“…19 Patients presenting with these descriptive factors should be informed about the increased likelihood of surgery. 19 There are no definite guidelines for the timeframe of follow-up for MWD patients treated conservatively. The authors recommend regular follow-up at 6 weeks, 3 months, 6 months, and annually from the initial visit to monitor the success of conservative treatment.…”

Section: Nonoperative Treatmentsmentioning

confidence: 99%

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A Novel Update on the Management of Müller-Weiss Disease: Presentation of a Treatment Algorithm

Angthong,

Younger,

Chuckpaiwong

et al. 2023

CARTILAGE

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Objective Müller-Weiss disease (MWD) is a challenging condition involving the perinavicular region in the initial stages and subsequently the entire foot in the later stages. The goal of this article is to describe the pathomechanics, clinical evaluation, and nonoperative and operative treatment, including a treatment algorithm, based on current evidence and the combined authors’ experience. Design We review the related articles and summarize the information about this condition. Results A number of related articles reveal that the treatments should focus on the management of degenerative regions and deformity correction to restore normal foot alignment and provide pain relief. Conclusion This systematic review proposes a treatment algorithm that is comprehensive and practical to apply for the management of MWD.

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“…Nonetheless, most researchers concur that MWD should be conservatively managed for the first 2-6 months, followed by surgical intervention for patients whose symptoms have not improved. 2,4,10,14,17,20,21,32 Additionally, the application of various surgical options focusing on peri-navicular arthrodesis has been described in a few case reports. [2][3][4]10,11,13,17,20,31,32 These surgical approaches share two common goals: (1) pain reduction via fusion of symptomatic degenerative joints and (2) restoration of the plantar vault and medial longitudinal arches via correction of the lateral Meary's line.…”

Section: Introductionmentioning

confidence: 99%

Müller-Weiss Disease: Midfoot Arthrodesis in Reduction vs Malreduction

Bai,

Xu,

Zhang

et al. 2024

Foot Ankle Int.

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Background: Midfoot arthrodesis is regarded as the main surgical approach for treating Müller-Weiss disease (MWD). This study aimed to investigate the incidence of postoperative pain during MWD treatment through midfoot reduction or malreduction during arthrodesis and to explore the factors influencing postoperative pain in patients with MWD. Methods: A total of 67 patients with MWD were recruited and divided into two groups according to whether midfoot alignment was reduced: reduction group ( n = 38) and malreduction group ( n = 29). Demographic characteristics before the operation and at the last follow-up, as well as clinical and radiographic parameters, were compared between the two groups. Clinical parameters included the American Orthopaedic Foot & Ankle Society score and visual analog scale score, whereas radiographic parameters included the calcaneal pitch angle, lateral Meary’s angle, talometatarsal-1 angle dorsoplantar (TMT1dp), talocalcaneal angle dorsoplantar (Kite angle), talonavicular coverage angle, and medial navicular pole extrusion. Postoperative complications and incidence of midfoot pain were evaluated at the last follow-up visit. Results: The reduction group exhibited better clinical and radiological parameters, including the TMT1dp and medial navicular pole extrusion, than the malreduction group at the last follow-up (all P < .05). However, the calcaneal pitch angle, lateral Meary’s angle, Kite angle, and talonavicular coverage angle did not significantly differ between the two groups (all P > .05). The overall incidence of midfoot pain was 26.4%. The reduction group showed a lower incidence of medial pain than the malreduction group (15.7% vs. 40.0%, P < .05). Regression analysis revealed that midfoot abduction, represented by the TMT1dp, was a critical factor for midfoot arthrodesis failure and that medial navicular pole extrusion was not correlated with postoperative midfoot pain. Conclusion: Midfoot reduction arthrodesis yields better clinical outcomes than malreduction arthrodesis. The TMT1dp, representing midfoot abduction, is a key factor for midfoot arthrodesis failure. The extruded medial navicular bone may not affect postoperative medial midfoot pain. Level of Evidence: Level III, retrospective comparative study.

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Müller-Weiss Disease: The Descriptive Factors of Failure Conservative Treatment

Cited by 10 publications

References 19 publications

Midterm outcomes of midfoot and hindfoot arthrodesis with strut allograft for Müller–Weiss disease

Midterm outcomes of midfoot and hindfoot arthrodesis with strut allograft for Müller–Weiss disease

A Novel Update on the Management of Müller-Weiss Disease: Presentation of a Treatment Algorithm

Müller-Weiss Disease: Midfoot Arthrodesis in Reduction vs Malreduction

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