Mueller-Weiss Syndrome
Mueller-Weiss syndrome refers to the spontaneous osteonecrosis of the lateral aspect of the tarsal navicular bone, which presents in the form of chronic medial pain of the midfoot or hindfoot, due to medial protrusion of talar head.
While its exact cause is debatable, trauma, osteochondritis, congenital dysplasia and mechanical overload are some of the factors thought to be responsible for the onset of the extremely rare disease.
The association of Mueller-Weiss syndrome with the development of a flatfoot deformity was explored by Wang et al. by examining six patients with a flatfoot condition caused by osteonecrosis of the navicular bone.
A significant finding of the study was that a flatfoot condition developed secondary to Mueller-Weiss syndrome had no specific early symptomatology or radiographic evidence, making an early diagnosis of the condition difficult.
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The imaging characteristics of osteonecrosis, as stated by the authors, involves medial and/or dorsal protrusion with lateral collapse. The lateral portion of the bone diminishes and the translucency increases followed by a comma-shaped deformity and protrusion and collapse of the dorsal portion.
The tarsal navicular bone developed deformities and fragmentation in the severe stages of the disease and the subtalar joint showed varus deformity; because of the considerable influence of Mueller-Weiss syndrome on foot function, the authors deemed an early diagnosis and treatment of the condition as essential.
According to DiGiovanni et al. in their study on osteonecrosis in the foot, the most consistent clinical findings of Mueller-Weiss syndrome are the presence of a heel varus deformity and pain that begins in the fifth decade; the former when combined with pes planus can result in a paradoxical pes planovarus.
Conservative treatment approaches for Mueller-Weiss syndrome in its earliest stages involve the use of foot supportive devices for the protection of the affected regions by offloading any stress or pressure.
This is achieved through the equal distribution of weight across the plantar surface of the foot while stabilising the arch and helping in the management of a pes planus condition, which if left untreated, can compound the effects of a disease like Mueller-Weiss.
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References:
- Wang X., Ma X., Zhang C., Huang J. Z., Jian J. Y. (2012) Flatfoot in Müller-Weiss syndrome: A case series. Journal of Medical Case Reports 6: August 2012, Vol. 1, No. 228, DOI: 10.1186/1752-1947-6-228
- DiGiovanni C. W., Patel A., Calfee R., Nickisch F. (2007) Osteonecrosis in the Foot. Journal of the American Academy of Orthopaedic Surgeons: April 2007, Vol. 15, No. 4, pp. 208-217
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