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Müller-Weiss is a disease characterized by deformation, fragmentation and necrosis of the navicular, which presents with midfoot varus and longstanding pain, mostly in females. It is related to delayed ossification due to physical or nutritional stress, associated with abnormal force distribution. There are still few studies on this condition and there is no consensus in the literature on its classification and treatment. At first, conservative treatment does not show positive results, only acute symptomatic improvement. Isolated talonavicular arthrodesis is the method most commonly adopted by specialists, showing good results and scores in the early stages, while triple and double arthrodesis is the choice in advanced stages. Knowledge of the radiology and findings is important for planning and individualizing the choice of treatment in each case. At the moment, there are several different techniques for approaching Müller-Weiss disease, however, studies evaluating long-term approaches as well as their complications need to be carried out. We present a systematic review on this disease. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion Arthrodesis, usage of metallic implants for internal fixation, is commonly employed as the primary treatment modality for Müller‐Weiss disease (MWD). Nevertheless, the efficacy of the current methods of fixation leaves room for improvement. Inadequate fixation strength and the risk of fixation failure are both critical concerns requiring attention. This study explored the clinical effects of implementing a modified fixation technique in talonavicular arthrodesis for the treatment of MWD.A total of 14 cases diagnosed with MWD undergoing talonavicular (TN) arthrodesis from January 2021 toMarch 2023 were included in the retrospective study. The fixation method for fusion involved the use of screws, with additional support from the shape‐memory alloy (SMA) staple. Relevant clinical outcomes and complications were evaluated preoperatively and postoperatively. Paired‐samples t‐test was used for all data comparisons.Radiographic evidence confirmed solid fusion, and follow‐up evaluations showed satisfactory results in all cases. The American Orthopedic Foot and Ankle Society (AOFAS) scores were elevated from 32.21 ± 4.0 (range: 22–38) preoperatively to 86.5 ± 2.7 (range: 81–90) postoperatively (p < 0.001). The visual analog scale (VAS) scores declined from 7.40 ± 0.8 (range: 6–8.5) preoperatively to 1.21 ± 1.1 (range: 0–3) postoperatively (p < 0.001). The lateral Meary's angle changed from 13.50 ± 5.2 (range: 8–24) preoperatively to 4.14 ± 2.9 (range: 1–11) degrees postoperatively (p < 0.001). The calcaneal pitch angle increased from 10.07 ± 4.0 (range: 5–19) preoperatively to 14.35 ± 4.0 (range: 8–21) degrees postoperatively (p < 0.001). The talar‐first metatarsal angle decreased from 11.71 ± 3.8 (range: 8–18) preoperatively to 4.28 ± 3.1 (range: 0–9) degrees postoperatively (p < 0.001). One patient was observed to experience delayed wound healing and wound infection. No nerve damage, malunion, pseudoarthrosis, or fixation failure were observed.The results indicated that the fusion of the TN joint using a combination of screws and shape memory alloy staples, could lead to favorable clinical outcomes and significantly enhance the quality of life for patients with MWD. This technique is not only safe and effective but also straightforward to perform. [ABSTRACT FROM AUTHOR]

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.

Background: Midfoot arthrodesis is regarded as the main surgical approach for treating Müller-Weiss disease (MWD). This study aimed to investigate the incidence of postoperative pain during MWD treatment through midfoot reduction or malreduction during arthrodesis and to explore the factors influencing postoperative pain in patients with MWD. Methods: A total of 67 patients with MWD were recruited and divided into two groups according to whether midfoot alignment was reduced: reduction group (n = 38) and malreduction group (n = 29). Demographic characteristics before the operation and at the last follow-up, as well as clinical and radiographic parameters, were compared between the two groups. Clinical parameters included the American Orthopaedic Foot & Ankle Society score and visual analog scale score, whereas radiographic parameters included the calcaneal pitch angle, lateral Meary's angle, talometatarsal-1 angle dorsoplantar (TMT1dp), talocalcaneal angle dorsoplantar (Kite angle), talonavicular coverage angle, and medial navicular pole extrusion. Postoperative complications and incidence of midfoot pain were evaluated at the last follow-up visit. Results: The reduction group exhibited better clinical and radiological parameters, including the TMT1dp and medial navicular pole extrusion, than the malreduction group at the last follow-up (all P <.05). However, the calcaneal pitch angle, lateral Meary's angle, Kite angle, and talonavicular coverage angle did not significantly differ between the two groups (all P >.05). The overall incidence of midfoot pain was 26.4%. The reduction group showed a lower incidence of medial pain than the malreduction group (15.7% vs. 40.0%, P <.05). Regression analysis revealed that midfoot abduction, represented by the TMT1dp, was a critical factor for midfoot arthrodesis failure and that medial navicular pole extrusion was not correlated with postoperative midfoot pain. Conclusion: Midfoot reduction arthrodesis yields better clinical outcomes than malreduction arthrodesis. The TMT1dp, representing midfoot abduction, is a key factor for midfoot arthrodesis failure. The extruded medial navicular bone may not affect postoperative medial midfoot pain. Level of Evidence: Level III, retrospective comparative study. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. 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. 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. 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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.

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. Level of evidence: Level III, retrospective comparative study. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of talonavicular-cuneiform joint fusion with iliac bone grafting and without bone grafting in the treatment of Müller-Weiss diseases (MWD)., Methods: The clinical data of 44 patients (44 feet) with MWD who received talonavicular-cuneiform joint fusion between January 2017 and November 2022 and met the selection criteria was retrospectively analyzed. Among them, 25 patients were treated with structural iliac bone grafting (bone grafting group) and 19 patients without bone grafting (non-bone grafting group). There was no significant difference ( P >0.05) in age, gender composition, body mass index, disease duration, affected side, Maceira stage, and preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) score, anteroposterior/lateral Meary angle, and Pitch angle between the two groups. Operation time, operation cost, and postoperative complications were recorded in the two groups. AOFAS and VAS scores were used to evaluate the function and pain degree of the affected foot. Meary angle and Pitch angle were measured on the X-ray film, and the joint fusion was observed after operation. The difference (change value) of the above indexes before and after operation was calculated for comparison between groups to evaluate the difference in effectiveness., Results: The operation was successfully completed in both groups, and the incisions in the two groups healed by first intention. The operation time and cost in the bone grafting group were significantly more than those in the non-bone grafting group ( P <0.05). All patients were followed up. The median follow-up time was 41.0 months (range, 16-77 months) in the non-bone grafting group and 40.0 months (range, 16-80 months) in the bone grafting group. There was skin numbness of the medial dorsalis of the foot in 1 case, internal fixation stimulation in 2 cases, and pain at the iliac bone harvesting area in 1 case of the bone grafting group. There was skin numbness of the medial dorsalis of the foot in 1 case and muscle atrophy of the lower limb in 1 case of the non-bone grafting group. There was no significant difference in the incidence of complications between the two groups ( P >0.05). At last follow-up, the AOFAS scores of the two groups significantly improved when compared with those before operation, while the VAS scores significantly decreased, the anteroposterior/lateral Meary angle and Pitch angle significantly improved, and the differences were significant ( P <0.05). There was no significant difference in the change values of outcome indicators between the two groups ( P >0.05). There was no delayed bone union or bone nonunion in both groups, and joint fusion was achieved at last follow-up., Conclusion: In the treatment of MWD, there is no significant difference in effectiveness and imaging improvement of talonavicular-cuneiform joint fusion combined with or without bone grafting. However, non-bone grafting can shorten the operation time, reduce the cost, and may avoid the complications of bone donor site.

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., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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. [ABSTRACT FROM AUTHOR]

The article offers information on Müller-Weiss disease (MWD), a foot condition characterized by deformity, sclerosis, and fragmentation of the navicular; and mentions historical and current literature regarding MWD, including the latest surgical interventions.

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.

Background: Müller-Weiss disease (MWD) remains a controversial painful foot condition without consensus on its pathogenesis or a gold standard treatment modality. The aim of the study was to evaluate the outcomes of calcaneal lengthening in adolescent patients with symptomatic MWD with flatfoot. Methods: The study included 13 feet of 7 patients including 5 females and 2 males who were treated from March 2012 until June 2015 by calcaneal lengthening. The mean age was 15.6 years. The mean duration of symptoms was 13.5 months. The body mass index (BMI) averaged 28.9 kg/m2 at presentation. The patients were followed up for a mean of 37.8 months. Results: The osteotomy healed in all cases after a mean of 7.2 weeks. The second foot was operated on after an average of 11.5 months. The mean talometatarsal-1 angle improved from 39.8 degrees preoperatively to 5.9 degrees. The mean preoperative calcaneal pitch angle of 7.5 degrees increased to an average of 17.8 degrees postoperatively. The mean American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Score was improved from 61.9 preoperatively to 94.2 postoperatively. Four patients had occasional exertional pain. Four feet had mild residual forefoot abduction. Arthrodesis was not needed in any case by the last follow-up. Conclusion: Early diagnosis of MWD with flatfoot was important and allowed for nonfusion treatment options. Calcaneal lengthening osteotomy in selected MWD cases achieved satisfactory outcomes with pain control, deformity correction, and improvement of the functional results. Level of Evidence: Level IV, retrospective case series. [ABSTRACT FROM AUTHOR]

Background: Various operative procedures have been reported for the treatment of Müller-Weiss disease (MWD). This study reports the midterm operative treatment results for stages II to V MWD with derotation of the talus and arthrodesis. Methods: Thirty-four patients (36 feet) with MWD were treated by talonavicular (TN) or talonavicular-cuneiform (TNC) arthrodesis in our center from 2008 to 2015. The affected feet were staged according to the Maceira staging system (stage II: 9; stage III: 10; stage IV: 9; stage V: 8). The American Orthopaedic Foot & Ankle Society (AOFAS) midfoot scale, the visual analog scale (VAS), and relative radiologic parameters were evaluated preoperatively and also during follow-up. The mean follow-up duration was 38.2 (range, 25-113 months). Results: The final follow-up showed satisfactory outcomes. Overall, the AOFAS scores improved from 41.5 (range, 20-56) to 85.3 (range, 68-100) points (P <.001), and the VAS score decreased from 5.7 (range, 3-8) to 0.9 (range, 0-4) points (P <.001). The Tomeno-Méary angle decreased from −6.7 (range, −26.4 to 17.7) to 0.7 (range, −5.3 to 7) degrees (P =.001). The calcaneal pitch angle increased from 13.7 (range, 4.1-26.2) to 22.0 (range, 13.3-28.9) degrees (P <.001). The anteroposterior (AP) talar–first metatarsal angle decreased from −15.8 (range, −30.1 to −13.7) to −7.0 (range, −25.9 to −8.9) degrees (P <.001), and the AP talocalcaneal angle increased from 14.7 (range, 4.7-22.3) to 22.1 (range, 13.4-29.5) degrees (P =.005). The AP talonavicular coverage angle decreased from −27.0 (range, −40.4 to −13.3) to −7.8 degrees (range, −20.7 to −1.8) degrees (P <.001). Conclusion: The midterm results found that the TN or TNC joint fusion could achieve a favorable clinical and radiologic outcome for patients with MWD. Even for the patients with severe deformities (stages IV-V), this treatment strategy could also achieve satisfactory deformity correction and functional improvement. Intraoperative restoration of talus rotation was the key to normal alignment of the subtalar joint/TN joint. Level of Evidence: Level IV, retrospective case series. [ABSTRACT FROM AUTHOR]

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, SF36 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. [ABSTRACT FROM AUTHOR]

Background and Aim: Müller-Weiss disease (MWD) is a rare anomaly of the tarsal scaphoid. Maceira and Rochera proposed the most commonly accepted etiopathogenic theory, in which dysplastic, mechanical, and socioeconomic environmental factors would be involved. The aim is to describe the clinical and sociodemographic characteristics of patients with MWD in our setting, corroborate their association with the socioeconomic factors previously described, estimate the influence of other factors involved in the development of MWD, and describe the treatment carried out., Materials and Methods: Retrospective study of 60 patients diagnosed with MWD in 2 tertiary hospitals of Valencia (Spain) between 2010 and 2021., Results: Sixty patients were included, 21 (35.0%) men and 39 (65.0%) women. In 29 (47.5%) cases, the disease was bilateral. The mean age of onset of symptomatology was 41.9±20.3 years. During childhood, 36 (60.0%) patients suffered migratory movements, and 26 (43.3%) had dental problems. The mean age of onset was 14.6±4.5 years. Thirty-five (58.3%) cases were treated orthopedically versus 25 (41.7%) treated surgically, 11 (18.3%) by calcaneal osteotomy, and 14 (23.3%) with arthrodesis., Conclusions: As in the series of Maceira and Rochera, we found a higher prevalence of MWD among those born around the Spanish Civil War and the period of massive migratory movements that occurred in the fifth decade of the 20th century. Treatment is still not well established., (Copyright © 2023 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background and Aim: Müller-Weiss disease (MWD) is a rare anomaly of the tarsal scaphoid. Maceira and Rochera proposed the most commonly accepted etiopathogenic theory, in which dysplastic, mechanical, and socioeconomic environmental factors would be involved. The aim is to describe the clinical and sociodemographic characteristics of patients with MWD in our setting, corroborate their association with the socioeconomic factors previously described, estimate the influence of other factors involved in the development of MWD, and describe the treatment carried out., Materials and Methods: Retrospective study of 60 patients diagnosed with MWD in 2 tertiary hospitals of Valencia (Spain) between 2010 and 2021., Results: Sixty patients were included, 21 (35.0%) men and 39 (65.0%) women. In 29 (47.5%) cases, the disease was bilateral. The mean age of onset of symptomatology was 41.9±20.3 years. During childhood, 36 (60.0%) patients suffered migratory movements, and 26 (43.3%) had dental problems. The mean age of onset was 14.6±4.5 years. Thirty-five (58.3%) cases were treated orthopedically versus 25 (41.7%) treated surgically, 11 (18.3%) by calcaneal osteotomy, and 14 (23.3%) with arthrodesis., Conclusions: As in the series of Maceira and Rochera, we found a higher prevalence of MWD among those born around the Spanish Civil War and the period of massive migratory movements that occurred in the fifth decade of the 20th century. Treatment is still not well established., (Copyright © 2023 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.)

Numerous surgical techniques for the treatment of Müller-Weiss disease (MWD) have been reported. However, no extensive clinical and radiographic studies of isolated talonavicular arthrodesis and MWD have been reported. The present retrospective cohort study examined the outcomes of isolated talonavicular arthrodesis at 3 to 8 years of follow-up in 16 MWD patients with a collapsed longitudinal arch and at least Maceira stage III. Demographic data, pre- and postoperative visual analog scale (VAS) scores for pain on walking and walking disability, foot and ankle outcome scores (FAOSs), and radiographic parameters were analyzed, with statistical significance at p  < .05. A survival analysis was used to determine the median time to union. The mean ± standard deviation pre- and postoperative VAS scores for pain on walking were 7.69 ± 1.62 and 2.19 ± 1.52 and the walking disability scores were 7.06 ± 2.11 and 2.31 ± 1.92, respectively. The pre- and postoperative FAOSs were 48.07 ± 21.50 and 82.27 ± 13.86 for activities of daily living, 30.86 ± 19.70 and 76.17 ± 22.39 for quality of life, and 20.93 ± 22.89 and 51.88 ± 23.66 for sports/recreation, respectively. The median pre- and postoperative FAOSs for the symptoms subscale were 73.22 (range 42.88 to 100.00) and 87.50 (35.71 to 100.00) and for pain were 34.72 (range 8.33 to 72.22) and 88.89 (54.41 to 100.00), respectively. Significant improvements occurred from preoperatively to postoperatively for VAS scores and FAOSs ( p  < .05). The mean pre- and postoperative calcaneal pitch angles were 11.31° ± 4.35° and 13.81 o ± 5.60 o , significant improvement ( p  = .016). Improvement was also seen midfoot abduction, with a mean pre- and postoperative anteroposterior Meary's angle of 14.38° ± 10.07° and 9.38° ± 12.21°. The survival analysis showed union was achieved in all patients, with a median time to union of 2 (95% confidence interval 1.03 to 3.00) months. Our data indicate that talonavicular arthrodesis provides satisfactory functional outcomes for MWD patients with a collapsed longitudinal arch. [ABSTRACT FROM AUTHOR]

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.

Background: Various methods of midfoot and hindfoot arthrodesis for treating symptomatic Müller-Weiss disease (MWD) have been reported in the literature. In this study, we present the results of a previously unreported method of treatment using a calcaneal osteotomy incorporating a wedge and lateral translation. Methods: Thirteen patients (14 feet) with MWD were treated with a calcaneal osteotomy and retrospectively reviewed. These included 7 females and 6 males, with an average age of 56 years (33-79 years), and an average symptoms duration of 10.6 years (1-16 years). The disease was staged according to Maceira, which included 5 feet in stage II, 4 feet in stage III, 4 feet in stage IV, and 1 foot in stage V. Pre- and postoperative visual analog scale (VAS) score, American Orthopaedic Foot & Ankle Society (AOFAS), radiologic examination, and patients’ satisfaction rate of the surgery were evaluated at an average of 3.7 years (range, 1-8.5 years) following surgery. Results: The final follow-up visit showed satisfactory outcomes, with VAS score reducing from the preoperative 8 (7-9) to postoperative 2 (0-4), whereas the AOFAS score improved from the preoperative 29 (20-44) to the postoperative 79 (70-88). The patient’s subjective ratings showed excellent results in 4 feet, good results in 8 feet, and fair outcomes in 2 feet. The hindfoot range of motion remained unchanged, as did the extent of the navicular complex arthritis, and no patient required an arthrodesis since surgery. Conclusion: A calcaneal osteotomy can be used as an alternative treatment option for selected MWD patients regardless of the radiologic stage of the disease. Level of Evidence: Level IV, retrospective case series. [ABSTRACT FROM AUTHOR]

Abstract: Müller–Weiss disease (MWD) is a complex idiopathic foot condition of the adult tarsal navicular characterised by progressive navicular fragmentation and talo-navicular joint destruction leading to mid and hind foot pain and deformit. This article reviews, the current literature regarding this condition and discusses the surgical treatment options. [Copyright &y& Elsevier]

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.

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.