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Mueller-Weiss Syndrome: What to Know

Bai W, Li Y, Shen G, Zhang H, Li X, Zhu Y. Bai W, et al. BMC Musculoskelet Disord. 2023 Mar 10;24(1):178. doi: 10.1186/s12891-023-06293-1. BMC Musculoskelet Disord. 2023. PMID: 36894915 Free PMC article.

Management of Müller-Weiss Disease

Müller-Weiss disease (MWD) is a dysplasia of the tarsal navicular. The shifting of the talar head laterally over the calcaneus drives the subtalar joint into varus. Failure to identify patients with paradoxic flatfoot varus may lead to the incorrect diagnosis and management. Conservative treatment with the use of rigid insoles with medial arch support and a lateral heel wedge is effective in most patients. Dwyer calcaneal osteotomy combined with lateral displacement seems to be a satisfactory treatment for patients who had failed to respond to conservative measures and a good alternative to the different types of perinavicular fusions.

Keywords: Avascular necrosis; Calcaneal osteotomy; Müller-Weiss disease; Paradoxic planovarus; Tarsal navicular; Varus hindfoot.

Copyright © 2018 Elsevier Inc. All rights reserved.

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Mueller-Weiss Syndrome: What to Know

Mueller-Weiss syndrome is a rare condition that causes severe arch pain on the inside of your mid- and hindfoot. It’s mostly found in people ages 40-60, and it’s much more common in women. It’s a progressive disease, meaning it gets worse over time, and it usually affects both of your feet. It causes flatfoot, which happens when your arch collapses. It can also cause your feet to be disfigured or bent out of shape.

What Causes Mueller-Weiss Syndrome?

Experts don’t know its exact cause. But they think it may be caused by things like:

  • A forceful squeeze or compression on the cluster of bones in your midfoot (known as the lesser tarsus)
  • A birth defect (congenital)
  • The loss of blood supply to your navicular bone (ischemia)

Your navicular bone is a half-moon or boat-shaped bone in the middle of your foot. If it suddenly loses its blood supply, your bone tissue starts to die, which then causes your joint to erode and your bone to collapse over time.

Your navicular bone also happens to be the last bone to fully form (known as ossification) in your foot during childhood. If this bone was slow to form, you might be at risk for Mueller-Weiss syndrome. Research also suggests you might be at higher risk if you’re obese or overweight.

What Are the Symptoms of Mueller-Weiss Syndrome?

  • Severe midfoot pain
  • Foot swelling
  • Tenderness on top of your feet
  • Arch pain
  • Trouble walking
  • Your navicular bone becomes comma or hourglass shaped.

But it might take months or years before you notice any symptoms.

How Is It Diagnosed?

Because Mueller-Weiss syndrome is uncommon, it’s often under- or misdiagnosed. That’s because doctors might be slow to identify flatfoot issues. If you have foot pain, especially in your arch or around your midfoot, let your doctor know.

They may refer you to a podiatrist (foot and ankle expert) or an orthopedist (doctor who specializes in bones). They’ll take your detailed medical history and examine your feet.

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They may run a few imaging tests on both of your feet. Those may include:

This will help them get a clear picture of what’s going on. Based on the amount of tissue death and erosion you may have in your navicular bone and its surrounding area, they’ll stage your condition and symptoms as mild (stage 1), moderate (stage 2-3), or severe (stage 4-5).

What Are the Treatment Options?

For now, there isn’t one best treatment for Mueller-Weiss syndrome. If your condition and symptoms are in the early stages, your doctor may prescribe nonsurgical therapies to help improve your quality of life.

These may include:

  • Anti-inflammatory medications (NSAIDs)
  • Braces that cover and support your foot and ankle (ankle-foot orthosis)
  • A temporary foot cast to stop you from moving your foot too much
  • Custom insoles or shoes for pain relief and arch support (orthotics)
  • Less physical activity

If these therapies don’t ease your pain, or your symptoms get worse over 6 months, your doctor might consider surgery. It’s often recommended if your condition is past stage 2.

The surgery might include a combination of:

Talonavicular cuneiform arthrodesis. This procedure is done to ease your foot pain and restore some arch support.

Bone grafting. For this procedure, your doctor will take a piece of bone from your hips, legs, or ribs and use it to repair your damaged foot bones. In some cases, they might use bone from a donor.

There are other types of surgeries for this condition, such as joint fusion, but they are less common. You may need physical therapy before and after your surgery to help you recover.

What’s the Outlook?

Over-the-counter pain medications, custom shoes, and foot braces might help ease your pain, take any pressure or stress off your feet, and improve your quality of life. If these therapies don’t help, talk to your doctor to find out if surgery might be an option for you.

Show Sources

Mayo Clinic: “Avascular Necrosis (Osteonecrosis).”

Johns Hopkins Medicine: “Bone Grafting.”

Indian Journal of Musculoskeletal Radiology: “Mueller Weiss syndrome, a less elucidated and unusual cause of midfoot pain: A case report.”

World Journal of Orthopedics: “Müller-Weiss disease: Four case reports.”

Foot and Ankle Clinics: “Management of Muller-Weiss Disease.”

Foot and Ankle Online Journal: “Case study of idiopathic degeneration of the talonavicular joint.”

American Journal of Roentgenology: “Imaging of Mueller-Weiss Syndrome: A Review of Clinical Presentations and Imaging Spectrum.”

Müller-Weiss syndrome

At the time the article was created Imran Jindani had no recorded disclosures.

Last revised:
16 Apr 2023, Jeremy Jones ◉
Disclosures:

At the time the article was last revised Jeremy Jones had no financial relationships to ineligible companies to disclose.

Revisions:
38 times, by 17 contributors – see full revision history and disclosures
Systems:
Tags:
Synonyms:

  • Brailsford disease
  • Mueller-Weiss syndrome
  • Mueller-Weiss disease
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URL of Article

Müller-Weiss syndrome, also known as Brailsford disease 3 , refers to spontaneous multifactorial adult onset osteonecrosis of the tarsal navicular. This syndrome is distinct from Köhler disease, the osteonecrosis of the tarsal navicular bone that occurs in children.

On this page:

  • Epidemiology
  • Radiographic features
  • Treatment and prognosis
  • History and etymology
  • See also
  • References
  • Cases and figures

Epidemiology

It occurs in adults between 40 and 60 years of age and is more common in females. Patients present with midfoot and hindfoot pain and pes planovarus.

Radiographic features

Plain radiograph

Plain radiographic features can include:

  • comma-shaped deformity due to the collapse of the lateral portion of the bone
  • medial or dorsal protrusion of a portion of the bone or the entire navicular bone

The disease may be bilateral or asymmetric and associated with pathologic fractures.

The disease can be staged radiographically.

CT
  • sclerosis with comma-shaped deformity of the lateral aspect
  • more advanced cases demonstrate further collapse and fragmentation
MRI
  • STIR/PDFS
    • bone marrow edema is seen as hyperintensity on these fat-suppressed fluid-sensitive sequences
    • highly sensitive to early changes due to its ability to detect marrow signal changes

    Treatment and prognosis

    The disease can be progressive at times, and it is associated with severe pain and disability. Initially, it is treated conservatively with analgesics and orthotics which if they fail then surgical treatment is considered.

    History and etymology

    Schmidt reported the first case in 1925. However, Walther Müller (1888) was the first to propose that the pathophysiology was due to an abnormal compressive force upon the ankle or a congenital abnormality. Konrad Weiss (1891) concluded that the appearances on plain film were analogous to those seen with Kienböck disease, i.e. an osteonecrotic etiology.

    See also

    • Köhler disease
    • osteonecrosis

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