Mueller-Weiss Disease of the Tarsal Navicular

NewsBot · Jun 19, 2020

Radiographic analysis of Müller-Weiss disease
JohnWong-Chung et al
Foot and Ankle Surgery; 18 June 2020

Highlights
•Significant correlations exist between Méary’s angle and navicular compression
•Medial extrusion of navicular correlates significantly with percentage compression
•Significant inverse relationships exist between Kite’s angle, compression and extrusion
•Paradoxical pes plano varus was present in only 26% of observed cases
•Universal lateral displacement calcaneal osteotomy alone should not be recommended
•Surgical treatment of Müller-Weiss disease should address the joints involved
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Background
The only classification of Müller-Weiss disease (MWD) is based primarily on Méary’s talo-first metatarsal angle. It describes increasing sag of the medial longitudinal arch with greater degrees of compression and fragmentation of the navicular. Purportedly, the talar head pushes the subtalar joint into varus and drives the medial pole of the navicular medially, as it protrudes inferiorly and laterally. Its authors stipulated heel varus as a pre-requisite, coining the term ‘paradoxical pes planus varus’ to define heel varus and flatfoot as hallmark deformities of the condition.

Methods
We measured Méary’s and Kite’s talocalcaneal angles, heel offset, anteroposterior thickness of the navicular at each naviculocuneiform (NC) joint, medial extrusion of the navicular and calculated percentage compression at each NC joint in 68 consecutive feet presenting with MWD. Morphology and activity at the various peri-navicular joints were studied using SPECT-CT in 45 feet.

Results
Inverse relationships between Méary’s angle and degree of navicular compression reach statistical significance at NC2 but not at NC3. Strong correlation exists between medial extrusion and percentage compression at NC2 and NC3. Medial extrusion is significantly greater on the affected side in unilateral cases and on the more compressed side in bilateral cases. Significant inverse relationships exist between Kite’s angle and percentage compression at both NC2 and NC3 and degree of medial extrusion of the navicular. No correlation was detected between Kite’s angle and either heel offset or Méary’s angle. Varus heel offset was present in only 33% of cases. The combination of heel varus and negative Méary’s angle was present in just 26% of cases, the commonest combination being heel valgus with sagging at 56%.

Conclusion
Our findings confirm part of Maceira’s hypothesized pathomechanism of MWD. Reductions in Kite’s talocalcaneal angle confirm that lateral and inferior protrusion of the talar head causes increasing compression and medial extrusion of the navicular. However, such shift of the talar head does not always lead to heel varus. As such, we caution against universal advocacy of lateral displacement calcaneal osteotomy, as the heel is not always in varus in MWD.
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NewsBot · Nov 28, 2020

Treatment with plantar supports in Müller-Weiss disease. Preliminary report
J Ruiz-Escobar et al
Acta Ortop Mex. Mar-Apr 2020;34(2):112-118

The objective of this work is to assess the efficacy of conservative treatment with orthopedic insoles in Müller-Weiss disease (EMW). The plantar support aims to pronounce the hindfoot and immobilize the talo-navicular, and naviculo-cuneiform joints or both at the same time, as an alternative to the valguizing osteotomy of the calcaneus and arthrodesis. The clinical and radiological characteristics of 10 cases of EMW in 8 patients under study are analyzed and the results obtained are evaluated. The manufacturing process of the plantar supports is commented, as well as the materials used. The sample size is not significant, however, preliminary, conservative treatment is possible in certain cases of EMW to relieve pain, improve gait dynamics and limit disease progression in the short-term.
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NewsBot · Dec 5, 2020

Müller-Weiss disease: Four case reports
Antonio Volpe et al
World J Orthop. 2020 Nov 18;11(11):507-515

Background: Müller-Weiss disease (MWD) is an idiopathic foot condition characterized by spontaneous tarsal "scaphoiditis" in adults. Frequently bilateral and affecting females during the 4th-6th decades of life, the pathogenesis of MWD remains unclear: It has been traditionally considered a spontaneous osteonecrosis of the navicular. The typical presentation of MWD is a long period of subtle discomfort followed by prolonged standing, atraumatic, disabling pain. Currently, there is no gold standard for the treatment of patients with MWD. Most support initial conservative therapy. Operative treatment should be considered for failure of conservative therapies longer than 6 months. The indication for surgery is severity of symptoms rather than severity of deformities. Operative treatment options include core decompression, internal fixation of the tarsal navicular, open or arthroscopic triple fusion, talo-navicular or talo-navicular-cuneiform arthrodesis, and navicular excision with reconstruction of the medial column.

Case summary: In this study, we report four patients affected by MWD. Clinical and radiographic assessment, follow-up and treatment are reported.

Conclusion: As it is frequently misdiagnosed, MWD is challenging for orthopedic surgeons. Early diagnosis and effective treatment are mandatory to avoid sequelae.
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NewsBot · Apr 12, 2021

Müller-Weiss Disease: The Descriptive Factors of Failure Conservative Treatment
Thos Harnroongroj, MD, Theerawoot Tharmviboonsri, MD, Bavornrit Chuckpaiwong, MD
Foot & Ankle International April 10, 2021

Background:
Conservative treatment is the first-line approach for Müller-Weiss disease (MWD). However, factors associated with the failure of conservative treatment have never been reported. Our objectives were to compare the differences in demographic and radiographic parameters between “successful” and “failure” conservative treatment in patients with MWD and identify descriptive factors associated with failure conservative treatment.

Methods:
We retrospectively reviewed 68 patients with MWD divided into 29 “failure” and 39 “successful” conservative treatment groups. Demographic characteristics, Foot and Ankle Outcome Score (FAOS), visual analog scale (VAS) scores for pain and walking disability, and radiographic parameters such as calcaneal pitch, lateral Meary, anteroposterior (AP) Meary angle, and talonavicular-naviculocuneiform arthritis were compared. Logistic regression analysis was performed to identify descriptive factors of failure conservative treatment. A P value <.05 was considered a statistically significant difference.

Results:
We found more severe VAS pain and walking disability scores and FAOS for the pain, activities of daily living, and quality of life subscales in the failure group (P < .05). Regression analysis demonstrated 2 significant descriptive factors associated with failure conservative treatment: abducted AP Meary angle >13.0 degrees and radiographic talonavicular arthritis. No demographic characteristics were found to be associated with failure conservative treatment.

Conclusion:
Midfoot abduction (AP Meary angle, >13 degrees) and radiographic talonavicular arthritis were factors associated with failure conservative treatment in MWD and should be determined concurrently with the clinical severity. Classification systems for MWD should include these factors.
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NewsBot · Oct 19, 2021

Clinical Presentation, Imaging Features, and Management of Müller–Weiss Disease
Shady Hermena, Monica Francis
Cureus 13(10): e18659. doi:10.7759/cureus.18659 (full text)

Müller-Weiss disease (MWD) is a rare condition of unclear pathogenesis that causes navicular bone collapse and fragmentation. MWD can be challenging to diagnose and presents with midfoot and hindfoot pain and deformities. Although its incidence is unknown, MWD more commonly affects women aged between 40 and 60 years. This study reviews and summarizes the published literature on MWD to allow a better understanding of the pathomechanics, presentation, imaging modalities, and treatment options for MWD.
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NewsBot · Jan 26, 2022

Hindfoot Varus Deformity: An Essential but Easily Neglected Pathological Change in Müller-Weiss Disease
Shuyuan Li, MD, PhD, Mark S. Myerson, MD, Cesar de Cesar Netto, MD, PhD
Foot & Ankle Orthopaedics January 21, 2022

Introduction/Purpose:
The key pathology of Müller-Weiss Disease (MWD) is fragmentation of the lateral pole of the navicular which leads to lateral rotation of the talar head, inversion of the subtalar joint, and eventually collapse of the medial arch with a paradoxical flatfoot deformity since the varus heel persists. Treatment for MWD should be based on an understanding of this unusual hind and midfoot deformity in order to achieve ideal outcomes. For years however, some authors have treated MWD as a flatfoot deformity instead of correction of the varus heel. This study used weightbearing CT (WBCT) images to demonstrate the structural and alignment changes of the hindfoot and medial arch in patients with MWD compared to those of controls and patients with adult acquired flatfoot deformity (AAFD).

Methods:
Twelve patients with 17 feet from two medical centers with a clinical diagnosis of MWD were retrospectively reviewed. Ten feet with flexible AAFD were chosen as the flatfoot control group. Ten feet without deformity, arthritis, a history of trauma, or prior surgical history in the foot and ankle were chosen as normal controls. The hindfoot moment arm (HMA), foot and ankle offset (FAO), middle facet subluxation (MFS), talonavicular joint coverage angle (TNCA), and the percentage of calcaneocuboid joint subluxation (CCS) measured on WBCT were used to assess the alignment of the hindfoot and peritalar joints. The arch height index was used to assess the height of the medial arch. Positive was used to reflect lateral subluxations and negative was for the medial ones. ANOVA test were used to compare data among the three groups with a normal distribution, while Wilcoxon test were used for non normal distribution.

Results:
According to WBCT analysis, patients with MWD showed totally different hindfoot alignment and peritalar subluxation characteristics compared to the AAFD and the normal control groups. In the order of MWD, AAFD and control, the mean HMA values were -3.44 mm, 15.75 mm, and 3.19 mm, FAO values were -0.72%, 7.42%, and 2.63%. TNCA values were -7.18, 22.11, and 11.37; MFS values were 14%, 45%, and 23%; CCS values were -0.19, 0 and -0.04. The arch height index values were 0.46, 0.45, and 0.58. There was statistically significant difference among the three groups in all the above parameters except the middle facet subluxation and fifth metatarsal medial cuneiform height ratios between the MWD group and the normal controls.

Conclusion:
This study confirmed that hindfoot varus is a typical feature of MWD. And this is the first study to demonstrate that peritalar subluxation is an important marker. With lateral rotation of the talar head, the subtalar joint is driven into varus, with medial subluxation of both the middle facet and the calcaneocuboid joint, resulting in peritalar subluxation opposite to that of AAFD. No significant difference between the medial arch of the MWD group and the controls was present. In conclusion, structural changes of the midfoot and hindfoot totally different from the characteristics of AAFD are present in MWD.
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NewsBot · May 10, 2022

Application value of imaging examination in the diagnosis of Muller-Weiss disease
Jing-Wu Yu et al
Zhongguo Gu Shang. 2022 May 25;35(5):476-80

Objective: To analyze radiological characteristics of Muller-Weiss disease, evaluate the clinical value of the imaging examination in diagnosis of Muller-Weiss disease.

Methods: The imaging data of 26 patients with Muller-Weiss disease were collected from September 2015 to August 2020, including 7 males and 19 females, aged 43 to 68 years old with an average of (52.7±4.6) years old. In the X-ray examination observed the shape and position of the navicular bone. The talar-first metatarsal angle(TFM) was measured on the weight-bearing anteroposterior radiograph. The arch angle and angle between mid-axis of talus and mid-axis of the first metatarsal(Meary angle) were measured on the weight-bearing lateral radiographs. The morphology, density, adjacent joint space and position of the navicular bone were evaluated by computed tomography(CT), and magnetic resonance imaging(MRI) was used to observe the shape, signal, cartilage and surrounding soft tissue changes of the navicular bone.

Results: Among 26 patients, 21 cases were unilateral and 5 cases were bilateral;X-ray examination showed that the lateral part of navicular bone of foot was compressed and flattened, showing"comma like"or"drop like", navicular moved to the medial side, partial fragmentation of bone, peripheral articular hyperplasia, uneven density and narrowing of relationship gap. According to Meary angle and deformity degree of the affected foot on the lateral X-ray of the load-bearing foot, Maceira staging was performed. There were 0 cases in stageⅠ, 2 cases in stage Ⅱ, 11 cases in stage Ⅲ, 9 cases in stage Ⅳand 4 cases in stage Ⅴ. CT examination showed bone fragmentation, medial displacement of navicular bone and formation of the talocalcaneal joint. MRI examination showed the irregular shape and uneven signal of navicular bone, narrowing of joint space, talocalcaneal joint surface hyperplasia and cartilage destruction, tarsal joint effusion and swelling of surrounding soft tissue.

Conclusion: Muller-Weiss disease has specific imaging manifestation, and an accurate diagnosis can be made based on the patient's age, gender, and clinincal history. Preoperative imaging examination can stage the disease, help clinicians to formulate better surgical plans, and postoperative imaging examination can better evaluate the surgical effect.
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NewsBot · Jul 31, 2022

Midterm outcomes of midfoot and hindfoot arthrodesis with strut allograft for Müller–Weiss disease
Tung-Ying Lee, Chang-Chin Wu, Kai-Chiang Yang, Kuang-Ting Yeh, Ing-Ho Chen & Chen-Chie Wang
BMC Musculoskeletal Disorders volume 23, Article number: 715 (2022)

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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NewsBot · Aug 2, 2022

Efficacy of Triple and Talonavicular Arthrodesis for the Treatment of III-V MüllerWeiss Disease
Liang Lu, et al
Tohoku Journal of Experimental Medicine

Müller-Weiss Disease (MWD) is a rare foot disease with unclear etiology but frequently
occurred in women. Due to the resistance to conservative treatment, surgical therapy
has gradually occupied a necessary position in the clinical management of MWD. Joint
fusion surgery is a commonly used treatment for MWD, which could effectively
alleviate pain, correct deformation, and restore function. A total of 12 MWD patients
(III-V stage) were enrolled in this study. All patients showed no significant
improvement in conservative treatment and further received the triple and talonavicular
arthrodesis. All patients were followed up with an average follow-up of 16.8 ± 1.19
months (mean ± SD). The triple and talonavicular arthrodesis significantly
ameliorated the pain and walking dysfunction in the affected foot. The American
Orthopedic Foot Andankle Society (AOFAS) scores dramatically increased from 43.4
± 16.1 to 85.3 ± 6.2. Meanwhile, the conducting of triple and talonavicular arthrodesis
improved the X-ray length (15.5 ± 0.8 vs. 14.3 ± 0.9 cm) and arch height (18.6 ± 0.9 vs.
10.2 ± 0.7 mm) and reduced the Meary-Tomeno angle (1.3 ± 2.5 vs. 2.14 ± 4.8°). The
triple and talonavicular arthrodesis achieved a satisfying therapeutic effect on MWD
patients at the III-V stage, which improved patients’ outcomes and the quality of life.
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NewsBot · Sep 29, 2022

Lateral osteotomy of the calcaneus in the treatment of Müller-Weiss disease
V Ponz-Lueza et al
Acta Ortop Mex. 2022 Jan-Feb;36(1):20-25.

Introduction: The deforming condition of the navicular bone known as Müller-Weiss disease (MWD) is a rare disease. Patients present with chronic pain in the talonavicular joint and a paradoxical flat foot with a varo hindfoot.

Objective: To analyze the clinical results of a lateral osteotomy of calcaneus applied to patients with MWD.

Material and methods: Retrospective observational study carried out in two hospitals. The series consists of nine cases in eight patients, all of them with symptomatic Müller-Weiss disease, treated by lateral osteotomy of the calcaneus between 2012 and 2017, obtaining an average follow-up of 4 years (2-6). The mean age was 62 years (50-75). In all patients, Costa-Bartani angles (CB), Kite angle and Calcaneal Inclination (CI) were measured. In addition, the Manchester Oxford Scale (MO) to measure the post-surgical satisfaction of patients.

Results: All patients report having improved their pain by obtaining a postoperative score on the mean Manchester Oxford scale of 32.54 points (15.62-53.75). In 66% of patients the CB angle improves, the Kite angle in 89% and the CI in 33%.

Conclusion: The improvement in the pain of the patients in our series is not accompanied by radiological changes in the same proportion, it is a simple and uncomplicated technique in our follow-up.
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NewsBot · Dec 15, 2022

The Use of SPECT-CT to Define Treatment for Müller-Weiss Disease: A Prospective Radiographic and Clinical Study
Chengyi Sun, MS, Benjamin Ebben, MD, […], and Ming-Zhu Zhang, MD, PhD
Foot & Ankle Orthopaedics

Introduction/Purpose:
Radiographic characteristics of Müller-Weiss disease (MWD) include compression and flattening of the lateral one-third of the tarsal navicular, lateral and inferior the shift of the talar head, followed by a varus hindfoot which produces a paradoxical planovarus. The radiographic Stage of the disease has no direct correlation with symptoms and therefore X-ray and CT have limitations in the surgical decision making for treatment. This study aimed to determine the predictive value of the use of SPECT-CT in surgical decision making. We hypothesized that SPECT-CT will highlight the specific joints actively involved in the disease process, and with the correct selective arthrodeses as well as intraoperative correction of malalignment of the hind and midfoot, improved clinical outcomes can be achieved.
Methods:
This was an IRB approved prospective study with 24 MWD patients (25 feet) enrolled. All patients failed conservative treatment and agreed to undergo SPECT-CT examination for further diagnostic purposes. The SPECT-CT scans were evaluated to identify the joints that were actively involved. Weightbearing X-rays (WBXR) and weightbearing CT scans (WBCT) were performed to assess the pre and postoperative midfoot and hindfoot alignment, including the talo-first metatarsal angle (TFMA), talonavicular coverage angle (TNCA), talocalcaneal angle (TCA), the Tomeno-Méary angle (TMA) and calcaneal pitch angle (CPA), and the hindfoot alignment angle (HAA). The surgical plan was based on the SPECT-CT and included guided arthrodesis, correction of hindfoot varus, talonavicular subluxation, and restoration of the medial arch. The AOFAS midfoot scale, visual analog scale (VAS), Foot and Ankle Ability Measure (FAAM) Sports subscale, and the 36-Item Short Form Health Survey (SF-36) were used pre and postoperatively to evaluate the clinical outcomes.
Results:
There were 20 females and 4 males with a mean age of 57.2 years and a mean duration of symptoms of 5.24 years. According to the Maceira staging system, there were 2 stage II, 8 stage III, 13 stage IV and 2 stage V. Three feet received isolated talonavicular arthrodesis, a talonavicular-cuneiform arthrodesis (10), triple arthrodesis (9), and triple plus navicular-cuneiform arthrodesis (3). The median follow-up time was 53.5 (range, 20-91) months. There were statistically significant improvements in the midfoot and hindfoot alignments (TNCA, TMA, CPA, HAA) and patient reported outcome measure scores (AOFAS, VAS, SF- 36 PF, SF-36 BP). Six patients required additional surgery (3 for hardware removal, and 3 for nonunion). No patient required revision surgery for arthritic pain in adjacent joints.
Conclusion:
SPECT-CT guided selective arthrodesis and correction of midfoot and hindfoot alignment can achieve both satisfactory clinical and radiographic outcomes in treating different stages of MWD. SPECT-CT is a very helpful tool to identify actively involved joints with arthritis secondary to the malalignment associated with this disease process, and avoids unnecessary arthrodesis of joints not actively involved in the disease process.
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NewsBot · Jan 24, 2023

Avascular necrosis of the foot and ankle: aetiology, investigation and management
Madeleine KJ.BickleyJamesLiNicola D.MackayAnna WP.Chapman
Orthopaedics and Trauma; 5 January 2023

Avascular necrosis (AVN) of the foot and ankle can pose both a diagnostic challenge, and a management dilemma. This paper seeks to describe the various types of AVN in the foot and ankle and clarify the expected presentation, examination findings, investigations and management strategies available. In addition, discussion of the relevant basic sciences, and the process of bone healing will facilitate a broader understanding of the condition, and the risk factors for its development. AVN can be secondary to trauma, as in most cases of talar AVN, or secondary to factors such as steroid use, alcohol excess, metabolic diseases, repetitive microtrauma, and abnormal biomechanics. Usually, a combination of the above is thought to be responsible. Many of the conditions described are established in childhood, either presenting at the time, or in the third or fourth decade. Management ranges from exercise limitation and offloading footwear, to surgical decompression, osteotomy, fusion or excision. AVN has a high morbidity and affects a young demographic, causing a substantial burden on healthcare. Early recognition of symptoms, and appropriate investigation and management could reduce the number of patients progressing to advanced disease, avoiding the frequently unsatisfactory surgical outcomes associated with options such as fusion and excision.
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NewsBot · Mar 14, 2023

Osteonecrosis of the Tarsal Navicular: Not Always Spontaneous!
Hanene Lassoued Ferjani et al
J Am Podiatr Med Assoc. 2023 Jan-Feb;113(1):21-070

Background: Mueller-Weiss disease, a rare and complex foot condition, is defined as spontaneous and progressive navicular fragmentation leading to midfoot pain and deformity. However, its exact etiopathogenesis remains unclear. We report a case series of tarsal navicular osteonecrosis to describe the clinical and imaging characteristics and etiologic profile of the disease.

Methods: This retrospective study included five women diagnosed as having tarsal navicular osteonecrosis. The following data were extracted from medical records: age, comorbidities, alcohol and tobacco consumption, history of trauma, clinical presentation, imaging modalities performed, treatment protocol, and outcomes.

Results: Five women with a mean age of 51.4 years (range, 39-68 years) were enrolled in the study. Mechanical pain and deformity over the dorsum of the midfoot was the main clinical presentation. Rheumatoid arthritis, granulomatosis with polyangiitis, and spondyloarthritis were reported by three patients. Radiographs revealed bilateral distribution in one patient. Three patients underwent computed tomography. It showed a fragmentation of the navicular bone in two cases.Magnetic resonance imaging was performed in one patient showing flattening of the lateral aspect of the navicular bone with signal abnormalities. Talonaviculocuneiform arthrodesis was performed in all of the patients.

Conclusions: Mueller-Weiss disease-like changes may occur in patients with an underlying inflammatory disease such as rheumatoid arthritis and spondyloarthritis.
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NewsBot · Mar 16, 2023

Talonavicular-cuneiform arthrodesis for the treatment of Müller-Weiss: mid-term results of 15 cases after 5 years
Wenbo Bai, Yinghao Li, Guodong Shen, Hongning Zhang, Xue Li & Yongzhan Zhu
BMC Musculoskeletal Disorders volume 24, Article number: 178 (2023)

Background
There is no gold standard for the operative treatment of patients with Müller-Weiss disease (MWD). This study reports the mid-term follow-up results for at least 5 years following talonavicular-cuneiform (TNC) arthrodesis for Müller-Weiss disease.

Methods
A total of 15 patients undergoing TNC arthrodesis for MWD were retrospectively reviewed between January 2015 and August 2017. Two senior doctors assessed the radiographic results twice at each visit (preoperative, three months after the operation, and final follow-up). The clinical results and complications from preoperative and final follow-up were recorded.

Results
The mean follow up period was 74.0 (range 64 to 90) months. The calcaneal pitch angle, lateral Meary's angle, anteroposterior (AP) Meary's angle, AP talocalcaneal angle, and talonavicular coverage were significantly different before and three months after the operation (p < 0.05). There was no significant difference between the radiographic results of three months after the operation and the final follow-up (p > 0.05). The radiological measurements of the two senior doctors were calculated and found to be moderate to strong (ICC:0.899–0.995). The AOFAS, VAS, and SF-12 scores significantly improved at the last follow-up compared to those before the operation (p < 0.05). Two patients experienced early complications, four had late complications, and one underwent a second operation of midfoot fusion with calcaneal osteotomy.

Conclusion
This research confirms that using TNC arthrodesis for the treatment of MWD can substantially improve the clinical and radiographic results. These results were maintained until mid-term follow-up.
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NewsBot · May 18, 2023

Towards understanding Müller-Weiss disease from an analysis of 95 cases
John Wong-Chung et al
Foot and Ankle Surgery; 16 May 2023

Background
The single existing classification of Müller-Weiss Disease (MWD), based solely upon Méary’s angle, serves neither as guide for prognosis nor treatment. This accounts for lack of gold standard in its management.

Methods
Navicular compression, medial extrusion, metatarsal lengths, Kite’s, lateral and dorsoplantar talo-first metatarsal angles were measured in 95 feet with MWD. Joints involved, presence and location of navicular fracture were recorded.

Results
Group 1 “early-onset” MWD feet (n=11) had greatest compression and medial extrusion, and lowest Kite’s angles. All except 1 were index minus and had lateral navicular fracture. Only 1 had moderate degeneration at the talonavicular joint (TNJ) with none requiring surgery yet.

Group 2 “Müller-Weissoid” feet (n=23) had radiologically normal navicular in their fifties and developed MWD on average 5 years later. They had the lowest compression and extrusion, and highest Kite’s angles. None had complete fracture. All had TNJ arthritis, with early changes at lateral naviculocuneiform joint (NCJ) in 43%.

Group 3 “late-onset” MWD presented in the sixth decade. Only TNJ was involved in Group 3 A (n=16). Group 3B (n=20) affected TNJ more than NCJ and had the greatest number of Maceira stage V disease. Group 3 C “reverse Müller-Weiss disease”, which affected NCJ more than TNJ (n=25), had greatest midfoot abduction and overlength of the second metatarsal. No fracture occurred in group 3 A compared to 65% and 32% in groups 3B and 3 C, respectively.

Conclusions
With need to compare like-for-like pathology, the proposed classification provides a common platform for reporting outcomes of different treatments. We theorize pathogenetic pathways in the various groups.
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NewsBot · Jun 13, 2023

Imaging of Müller-Weiss Disease
Javier Carrascoso , Manuel Monteagudo , Eva Llopis , Mar Jiménez , Manuel Recio , Ernesto Maceira
Semin Musculoskelet Radiol 2023; 27(03): 293-307

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.
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NewsBot · Sep 19, 2023

The Framing of ‘Playing
Through the Pain’ in the
Media: An Investigation of
Rafael Nadal During the
2022 French Open
Daniel Read and Lauren M. Burch
Communication & Sport 2023, Vol. 0(0) 1–22 © The Author(s) 2023

Analgesic medication (i.e., painkillers) provides a legal method for athletes to compete
through pain. Masking injury presents the risk of injury exacerbation as well as potential
organ damage, long-term musculoskeletal conditions, and dependence. The framing of
elite athletes using medication to compete through injury could influence the attitudes
and behaviors of other sportspersons including junior and recreational participants.
This research explored the framing of tennis player Rafael Nadal’s anesthetic injections
at the 2022 French Open via content analysis of 103 news articles. The results revealed
global news lacked critical coverage, normalized competing through injury under moral
frames, and valorized such behavior as heroic and courageous. Further, news coverage
can be classified into four types: individual experience, medical, physical status, and
policy. Identification of frames related to competing through injury can inform
messaging to promote safer practices concerning painkiller use.
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NewsBot · Oct 19, 2023

A Novel Update on the Management of Müller-Weiss Disease: Presentation of a Treatment Algorithm
Chayanin Angthong et al
Cartilage. 2023 Oct 18

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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NewsBot · Jan 5, 2024

Outcomes of Selective Arthrodesis Based on Joints Affected in 33 Feet With Müller-Weiss Disease
John Wong-Chung et al
J Foot Ankle Surg. 2023 Dec 6

No consensus exists regarding operative treatment of Müller-Weiss disease (MWD). Its only classification is based solely on Méary's angle and serves neither as guide to management nor prognosis. We report on 33 feet that underwent surgery following failed conservative management. Treatment was directed towards joint(s) involved, as determined by clinical examination, plain radiography and SPECT-CT. Thus, surgery consisted of isolated talonavicular in 6 feet, triple in 8, subtalar and talonavicular in 7, talonaviculocuneiform in 4, talonaviculocuneiform with interpositional tricortical iliac crest graft in 6 and pantalar arthrodesis in 2. PROMIS scores for pain interference and depression decreased significantly (p < .001) with significant accompanying increase in physical function (p = .003). Union occurred in 31 of 33 feet (94%) with complete resolution of pain at an average follow-up of 84 months. Of the 2 nonunions, 1 had fracture through the lateral navicular, and the other marked sclerosis and avascularity of the lateral navicular. We describe our pathways for selecting arthrodesis based on the joints affected. Isolated talonavicular arthrodesis was performed in early stages of MWD, which begins at the talonavicular articulation. When disease extended to both sides of the navicular, we performed talonaviculocuneiform arthrodesis. When considering isolated talonavicular, double medial or triple arthrodesis, there should be adequate cancellous bone stock remaining in the lateral part of the navicular, as determined on medial oblique radiographs and CT scan. In case of inadequate bone stock or fracture through the lateral navicular, talonaviculocuneiform arthrodesis with interpositional iliac crest bone graft is recommended.
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NewsBot · Mar 4, 2024

Mueller-Weiss syndrome, An unexpected cause of mid foot pain in adolescents
Dana Alomran, Karim Gaber, Waleed Kishta
Journal of Orthopaedic Reports
Volume 3, Issue 1, March 2024, 100240

Case
This is a case report of a 16-year-old male patient with chronic midfoot pain and rigid pes planus. The main differential diagnosis included tarsal coalition, accessory navicular and residual Kohler's disease, but imaging modalities confirmed Mueller-Weiss syndrome, a rare condition of spontaneous osteonecrosis of the navicular bone typically found in adults. To the best of our knowledge, this is the first reported case of Mueller-Weiss syndrome in a patient younger than 18 years old. Surgical intervention was carried out for the case and complete resolution of symptoms was achieved in the first 3 months.

Conclusion
This case report underscores the importance of appropriate imaging modalities and individualized treatment plans for each patient with midfoot pain, particularly in younger populations with rigid pes planus. It also highlights the need for increased awareness of rare conditions such as Mueller-Weiss syndrome in the differential diagnosis of midfoot pain in adolescents.
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Mueller-Weiss Disease of the Tarsal Navicular

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Mueller-Weiss Disease of the Tarsal Navicular

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Mueller TPD Orthotic info.

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