Search

A Doença de Müller-Weiss gera alterações biomecânicas complexas dos pés, sendo sua verdadeira prevalência desconhecida. Muitos casos são subdiagnosticados, visto que alguns pacientes não apresentam sintomas, mas principalmente porque o diagnóstico não faz parte do escopo do ortopedista em geral. Quando presente, a característica clínica mais marcante é a presença do pé plano paradoxal com dor no mediopé de início insidioso, dificuldade para caminhar e desabamento progressivo do arco plantar. Frequentemente acomete mulheres com envolvimento bilateral. O tratamento inicial compreende mudanças no estilo de vida (como perda de peso e prática de atividades físicas) modificações no uso de calçados e palmilhas sob molde com elevação de toda borda lateral. Nos casos não responsivos ao tratamento clínico, a cirurgia é uma opção viável. A artrodese talo-naviculo-cuneiforme é uma das opções cirúrgicas para melhora da dor e correção da deformidade com recuperação do alinhamento do retropé. Essa revisão sistemática visa discutir a importância do tema, uma vez que comumente subdiagnosticado, chega ao médico ortopedista com complexas alterações anatômicas e biomecânicas, trazendo maiores dificuldades para obtenção de um resultado satisfatório.

BackgroundThis study reported the individual surgical treatment of 12 cases with stage IV Müller-Weiss disease (MWD) according to CT/MRI examination.MethodsIn total, 12 cases diagnosed with stage IV MWD in our hospital from 2015 to 2019 were included in the retrospective study. Relevant clinical outcomes were evaluated preoperatively and postoperatively.ResultsThe follow-up results showed satisfactory outcomes in all cases. All the cases were presented with tenderness and chronic pain on the midfoot dorsum, and three cases were also presented with tenderness and pain on the lateral side of the midfoot, in which calcaneal cuboid arthritis was revealed by CT/MRI. The American Orthopedic Foot and Ankle Society (AOFAS) scores elevated from 62.5 ± 6.8 (range: 53–74) preoperatively to 95.3 ± 7.2 (range: 73–100) postoperatively (P < 0.005). The Visual Analog Scale (VAS) scores declined from 4.2 ± 0.9 (range: 3–5.5) preoperatively to 0.5 ± 0.3 (range: 0–2) postoperatively (P < 0.001). On the weight-bearing lateral view of the foot, the Tomeno-Méary angle (TM lat) changed from −11.2 ± 4.2 (range: −17.2 to −2.8) degrees preoperatively to −2.4 ± 3.9 (range: −10.2 to 5.2) degrees postoperatively (P < 0.001).ConclusionsThe fusion of the talus-navicular joint and the adjacent affected joint provide good clinical outcomes. The CT/MRI scans are helpful to identify the adjacent joint arthritis and provide indications for individual treatment for Stage IV MWD.

Abstract Background The study aimed to introduce the isolated talonavicular and talonavicular-cuneiform arthrodesis for the stage III and IV Müller-Weiss disease and analyze their clinical outcomes. Methods Thirty patients of stage III and IV Müller-Weiss disease were divided into the talonavicular (TN) arthrodesis group and the talonavicular-cuneiform (TNC) arthrodesis group according to the perinavicular osteoarthritis by MRI scans. For the isolated talonavicular arthrodesis group, 16 patients underwent talonavicular arthrodesis with two 4.0 mm hollow headless compression screws. For the TNC arthrodesis group, 14 patients were received the TNC arthrodesis with reverse “V” shape osteotomy and autoallergic iliac bone graft. All patients were followed up at 3, 6, 9, and 12 months, and per 6 months after 1 year, by the AOFAS ankle-midfoot scores, and evaluated by radiographic measurements. Results All of them were followed up in two groups and all patients were satisfied with their clinical results. At the TN arthrodesis group, the patients’ mean was 39.8 months (range, 11–66 months) follow-up. The mean AOFAS ankle and hindfoot scores had improved from 38.3 ± 5.1 preoperatively to 88.9 ± 1.9 at the last postoperative assessment. At the TNC arthrodesis group, the mean follow-up was 51.7 months (range, 12–90 months). The mean AOFAS ankle and hindfoot scores were 40.1 ± 7.9 preoperatively to 90.1 ± 2.0 at the last postoperative. All of the cases were solid fusion on the radiograph. Conclusions According to MRI evaluation, either TN or TNC arthrodesis for stage III or IV Müller-Weiss disease have the good clinical outcomes with solid fusion rate and obvious improvement of the quality of life of patients.

This study aims to describe the clinical results of isolated talonavicular arthrodesis in rare Müller-Weiss disease, spontaneous osteonecrosis of the navicular in adults. From June 2001 to April 2010, we performed isolated talonavicular arthrodesis on 13 feet of 13 patients (mean age: 55.6 years) with Müller-Weiss disease. The feet were staged by the preoperative radiographs according to the Maceira classification. The average modified American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score improved from 48.5 points preoperatively to 87.2 points at final follow-up (mean 51 months, range 10–114 months). Union was achieved in 10 cases (76.9%). If the subtalar and calcaneocuboid joints are relatively healthy, isolated talonavicular arthrodesis may be an effective and reliable surgical option for treatment of Müller-Weiss disease that is resistant to conservative treatment.