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Müller-Weiss disease of the tarsal navicular is a rare condition, the etiology of which remains unclear. We present the case of a 28-year-old woman with classic radiographic findings consistent with Müller-Weiss disease. The patient was successfully treated with a talonavicular-cuneiform arthrodesis of her right foot. Radiographs at 6 months postoperatively demonstrated a successful medial arch fusion. At 38 months follow-up, the patient was asymptomatic. The American Academy of Orthopaedic Surgeons ankle hindfoot score was 97, compared with a preoperative score of 32
Mueller-Weiss syndrome is spontaneous osteonecrosis of the tarsal navicular in adults.
This syndrome is distinct from the osteochondrosis of the tarsal navicular bone that occurs in children (Köhler disease).
More common in female.
The disease can be progressive at times, and it is associated with severe pain and disability.
The disease may be bilateral or asymmetric and associated with pathologic fractures.
Spontaneous osteonecrosis of the navicular bone in adults is a rare entity, known as Muller-Weiss syndrome. We report here on our experience with six patients with Muller-Weiss syndrome accompanied by flatfoot deformity, but on a literature search found no reports on this phenomenon. Because the natural history and treatment are controversial, anunderstanding of how to manage this deformity may be helpful for surgeons when choosing the most appropriate operative procedure.
Six patients (five women, one man; average age, 54 years) with flatfoot caused byosteonecrosis of the navicular bone were followed up between January 2005 and December2008 (mean follow-up period, 23.2 months). Conservative treatment, such as physicaltherapy, and non-steroidal anti-inflammatory drugs were used, but failed. Physicalexaminations revealed flattening of the medial arch of the involved foot and mild tendernessat the mid-tarsal joint. Weight-bearing X-rays (anterior-posterior and lateral views),computed tomography, and magnetic resonance imaging scans were performed for each case. Talonavicular jointarthrodesis was performed in cases of single talonavicular joint arthritis. Triple arthrodesiswas performed in cases of triple joint arthritis to reconstruct the medial arch. Clinicaloutcomes were assessed using the American Orthopaedic Foot and Ankle Society ankle-hindfootscale; the scores were 63.0 pre-operatively and 89.8 post-operatively. All patientsdeveloped bony fusion.
The reason for the development of flatfoot in patients with Muller-Weiss syndrome isunknown. Surgical treatment may achieve favorable outcomes in terms of deformitycorrection, pain relief, and functional restoration. The choice of operative procedure maydiffer in patients with both flatfoot and posterior tibial tendon dysfunction.
We aimed to report our results of peri-navicular arthrodesis with autologous iliac bone graft for Stage III Müller-Weiss disease.
Nine cases of Stage III Müller-Weiss disease according to the Maceira classification (four male and five female) with average age of 48.2 (range, 41 to 58) years, had mild or severe midfoot pain with the longitudinal arch collapse. The patients, all of whom had failed conservative treatment for more than 6 months, underwent peri-navicular arthrodesis. All patients were followed up at 3, 6, 9, and 12 months, and then every 6 months with AOFAS ankle-hindfoot scores and radiographic measurements. Mean followup time for radiological and clinical evaluation was 22.4 (rangem 12 to 52) months.
All patients were satisfied with their clinical results without pain 12 months after surgery. The mean AOFAS ankle-hindfoot scores improved from 40.1±8.3 preoperatively to 90.9±2.1 at the last followup (p<0.05). A solid fusion was found in all cases at 3 months after surgery by radiographic and clinical evaluation. The average longitudinal arch height increased from 46.1±2.1 mm preoperatively to 53.5±2.3 mm at the last followup (p<0.05) on the lateral weightbearing radiograph.
The peri-navicular arthrodesis with autologous iliac bone graft resulted in a good outcome for Stage III Müller-Weiss disease with good clinical outcomes, high fusion rate, and obvious improvement of the longitudinal arch height.