Wong GNL, Tan TJ (2016) MR imaging as a problem solving tool in posterior ankle pain: a review. Miller TT (2002) Painful accessory bones of the foot. Nwawka OK, Hayashi D, Diaz LE, Goud AR, Arndt WF, Roemer FW, Malguria N, Guermazi A (2013) Sesamoids and accessory ossicles of the foot: anatomical variability and related pathology. Sarin VK, Erickson GM, Giori NJ, Bergman AG, Carter DR (1999) Coincident development of sesamoid bones and clues to their evolution. Poster Nº.: C-1797ĭoyle T, Napier RJ, Wong-Chung J (2012) Recognition and management of Müller-Weiss disease.Mellado JM, Ramos A, Salvado E et al (2003) Accessory ossicles and sesamoid bones of the ankle and foot: imaging findings, clinical significance and differential diagnosis. Foot Ankle Clin N Am 9:65-72 (PMID: 15062214)Ĭarrascoso Arranz J, Maceira Suárez E, M. (2004) Arthrodesis of the talonavicular-cuneiform joints in Müller-Weiss disease. (PMID: 3260727)įernández de Retana P, Maceira E, Fernández-Valencia JA, Suso S. American Journal of Roentgenology 151(2):355-8. (1988) Spontaneous osteonecrosis of the tarsal navicular in adults: imaging findings. Haller J, Sartoris DJ, Resnick D, Pathria MN, Berthoty D, Howard B, and Nordstrom D. (2004) Müller-Weiss disease: clinical and biomechanical features. The Journal of Foot&Ankle Surgery 50(2):221-4. (2011) Spontaneous osteonecrosis of the tarsal navicular in an adult: Mueller-Weiss syndrome. (2012) Flatfoot in Müller-Weiss syndrome: a case series. Wang X, Ma X, Zhang C, Huang J-Z, and Jiang J-Y. Multiple surgical techniques have been used: pinning of the navicular, excision of the dorsal extruded fragment, talonavicular arthrodesis, naviculocuneiform arthrodesis, There is no consensus on the appropriate surgical treatment of Müller-Weiss syndrome. Surgical treatment may be indicated when pain and dysfunction persist in spite of the correct orthotic and rehabilitation treatment. Treatment of Müller-Weiss syndrome generally consists of non–weight-bearing cast immobilization and the use of oral anti-inflammatory and analgesic medications. The main advantage of MR is the increased sensitivity in depicting the early changes compared to plain radiographs and CT.ĭifferential diagnosis of Müller-Weiss syndrome includes neuropathic arthropathy, gout, rheumatic conditions, fractures and post-traumatic conditions, osteochondral lesions, iatrogenic surgery, atypical accessory navicular, etc. Intravenous contrast is not required for the diagnosis. STIR/PD fat-sat images reveal bone marrow oedema and small joint effusion when present. MR features show a homogeneous decrease in the signal intensity of the navicular bone on T1 -weighted images. Also, CT can be helpful to precisely define the site(s) of fragmentation, which can be difficult to see on routine radiography alone. On CT similar findings to plain radiographs may be recognized. A short first metatarsal bone also favours this abnormal force distribution pattern. Subtalar varus is commonly associated, with a lateral shift of the head of the talus that compress the lateral half of the navicular against the lateral cuneiforms. Irregularity, sclerosis, fracture and fragmentation may be also present. X-ray reveals a comma-shaped or wedge-shaped navicular bone on the anteroposterior view which corresponds to deformity and collapse on the lateral aspect of the bone caused by lateral compression. However, Köhler’s disease occurs in children and tends to be unilateral in presentation. It commonly affects women and it shows bilateral distribution. Patients should also be questioned about nutritional deficiencies in childhood, tooth loss before the third decade, endocrinopathies, or other systemic diseases, as the condition's aetiology is still unclear and theories about a nutritional origin have been proposed. Müller-Weiss syndrome is thought to develop as a result of excessive mechanical strain, both compressive and tensile, affecting the bone's vascular supply. It is a different entity than Köhler disease, which is an osteochondrosis of the tarsal navicular bone that occurs in children. Spontaneous osteonecrosis of the tarsal navicular bone in adults is called Müller-Weiss syndrome.
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