Mueller-Weiss Syndrome: Throw the kitchen sink at it

Müller-Weiss Syndrome (Mueller-Weiss Disease) is an uncommon spontaneous avascular necrosis of the navicular bone in feet of adults. It was first described separately in the German literature by Walther Müller in 1927 and by Konrad Weiss in 1927, hence the hyphenated eponym. It is more common in females than males, mostly between the ages of 40-60 years.

The cause of Mueller-Weiss Syndrome is not clear, but does involve a disruption of the blood supply to the navicular bone for some unknown reason. The navicular’s position at the top of the osseous arch structure of the foot does mean that it is subjected to significant force and load.

Clinical Features of Mueller-Weiss Syndrome:

There is typically a description of chronic midfoot pain with swelling and tenderness over the dorsomedial aspect of the navicular with a history of acute trauma. There may be a stiffness of the joints around the navicular. A flat pronated foot with a lower arch is also typical. The more painful cases may need up to a month in a short leg walking brace and then the use of foot orthotics and sturdy footwear, perhaps with a rocker.

On x-ray the changes in arch alignment can be seen. It is also possible to see some compression of the navicular bone, fragmentation as well as a comma shaped navicular bone and joint space narrowing, especially of the talonavicular joint.

Treatment of Mueller-Weiss Disease

The main approach to the treatment is the use of foot orthotic devices to support the midfoot and reduce the loads on the navicular bone. This will need to be done in conjunction with a reduction in physical activity levels down to tolerable amounts.

Short term pain relief with NSAIDs may be used.

For those cases that do not respond to foot orthotic support and sturdy footwear surgical options can be considered to fuse the symptomatic degenerative joints and restore the alignment of the medial longitudinal arch of the foot. Sometimes the Achilles tendon is lengthened as well.

Forum Discussion on Müller-Weiss Disease

Mueller-Weiss Disease of the Tarsal Navicular

Person Opinion on Mueller-Weiss Syndrome

I followed with interest the case of the tennis player, Rafael Nadal, who had Mueller-Weiss disease and was reported in the media has having local anaesthetic injections to allow him to play. I blogged about this as it reminded me of a book, The Athletes Dilemma, that I think all clinicians who treat athletes need to read. The book talks about the lengths high level athletes can go to, such as Nadal playing with local anaesthetic injection and the risk that puts them at long term for short term glory and the example that this is setting for children.