Percutaneous decompression for the treatment of Mueller–Weiss syndrome

Abstract

This report describes the case of a young athlete, who presented with a painful foot and was eventually diagnosed with early-stage Mueller-Weiss syndrome (spontaneous osteonecrosis of the navicular) by MRI. As non-operative management was unsuccessful, a percutaneous decompression of the navicular was performed. The patient made a full recovery and was able to return to her previous level of sporting activity. Subsequent imaging showed complete remodelling of the bony architecture of the affected navicular.

Isolated Talonavicular Fusion With Tension Band for Müller-Weiss Syndrome

“…However, often conservative therapy does not relieve the patient's pain, leading to operative interventions. 7,9,11,14,22,[24][25][26]28 Furthermore, if left untreated, MWS can lead to a permanent disability. 21 Ideally, operative correction should restore the navicular height and realign the naviculocuneiform (NC) joint to restore the medial column and prevent NC osteoarthritis.…”

Open triple fusion versus TNC arthrodesis in the treatment of Mueller-Weiss disease

“…Mueller-Weiss disease refers to spontaneous osteonecrosis of the navicular in adults, and it occurs more often in women than in men by a ratio of 6:4 [1, 12]. Most patients complained about long-standing midfoot pain on the dorsum of foot.…”

“…Percutaneous decompression of the navicular was suitable for early stages of MWD. However, in practice, most of the patients have established arthritic changes of mid- and hindfoot deformity by the time the condition is diagnosed, and at this stage, core decompression is unlikely to be helpful [12]. Isolated talonavicular arthrodesis usually fails to resolve the incongruence of naviculocuneiform joint and carries a high risk of pseudarthrosis.…”

“…Conservative management is composed of insoles, orthoses, decreased physical activity, non-weightbearing cast immobilization, and/or nonsteroidal anti-inflammatory medication [7–12], but it often fails when using immobilization by orthoses and anti-inflammatory medications [9, 13]. Indeed, surgery is required in a large number of cases.…”

“…Operative treatment should be considered when conservative treatment failed to relieve the symptom [7]. Several operative techniques have been proposed for midfoot pain relief and deformity correction: internal fixation of navicular bone, simple excision of the dorsolateral fragment of the navicular with bone graft [10, 14], percutaneous drilling decompression [12], isolated talonavicular arthrodesis [10, 15, 16], talonavicular-cuneiform (TNC) arthrodesis [7], and double fusion or triple arthrodesis [8]. However, it remains uncertain that which kind of treatment is the best method to treat which type of MWD.…”