Mueller–Weiss syndrome

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Mueller–Weiss syndrome
Other namesMueller–Weiss disease, Müller–Weiss syndrome, Brailsford disease
pain
Usual onsetSub-acute
TreatmentMedication, surgery

Mueller–Weiss syndrome, also known as Mueller–Weiss disease, is a rare

osteonecrosis, with blood flow cutoff to the navicular.[1][6]

Presentation

The onset is

Charcot arthropathy.[9]

Navicular

The bones of the tarsus with A=calcaneus, B=talus bone, C=cuboid bone, D=navicular bone, E=lateral cuneiform, F=intermediate cuneiform and G=medial cuneiform. In dark grey the metatarsals. Left image: seen from below. Right image: seen from above
Navicular bone - posterior view

The

fibrous) joints and has a significant function in maintaining the arch and the dynamic biomechanics of walking. The middle third of the bone lacks blood vessel penetration and it bears the majority of the load applied to the tarsal bones during weight bearing. Its vascular and biomechanical properties make it susceptible to injury. This may partly explain a higher risk of stress fractures and osteonecrosis in this location. Athletes who run, cut and pivot are particularly susceptible to injuries in this area. It is known as the keystone of the foot[10] and injuries to it can be "exasperating."[11]

Pathogenesis/pathomechanics

Talocalcaneonavicular articulations exposed from above by removing the talus

Mueller–Weiss syndrome had been traditionally considered a spontaneous osteonecrosis of the navicular bone, but there is no certain pathogenetic explanation. Pathologic evidence of osteonecrosis (empty

flat foot, with a varus deformity instead of a valgus.[1] Multiple ligaments and the posterior tibial tendon attach to the navicular. These perform a significant function in acting as a dynamic stabilizer and maintaining bipedal biomechanics.[11]

Regardless of the exact cause, the pathogenesis of Mueller-Weiss syndrome is probably multifactorial and related to chronic loading on a suboptimally ossified navicular—a bone that is predisposed to central ischemia owing to its centripetal vascular perfusion arch.[11]

Diagnosis

Weight-bearing

MRI can be useful early in the disease to separate MWS from mimics and demonstrate bone marrow changes and effusion in adjacent joints; this will help making a diagnosis before changes on conventional weight-bearing X-rays.[16] Despite its distinctive radiological features, Mueller–Weiss syndrome is often a diagnosis of exclusion[7] and is felt to be under-diagnosed.[6][17]

Characteristic findings of conventional radiology include:[18]

  • Normal earliest in the disease
  • Lateral collapse of the navicular
  • Dorsomedial subluxation of the remnant navicular
  • Lateral deviation of the talus

Severe disease may demonstrate:[18]

  • Pes planus
    (flat foot)
  • talonavicular joint with or without the involvement of other midfoot joints[17]

Treatment

Treatment should be commenced as early as possible. Initial treatment is

anti-inflammatories. Failure of conservative management is more likely in patients with mid-foot abduction and radiologically noted talonavicular arthritis.[4][20] Surgical options are reserved for greater than six months of severe pain. There is no gold standard of treatment, with many surgical approaches.[9]

History

In 1927 Walther Mueller, a

Keinbock's disease, another osteonecrotic condition.[22][21] Since then controversy has persisted around the cause and pathogenesis of the disease.[8][1] In 1939 James Frederick Brailsford, an English radiologist, described nine cases in adult women.[21]
Mueller–Weiss syndrome is also known as Brailsford disease.

Society and culture

Rafael Nadal has had symptoms of Mueller–Weiss in his left foot since the early part of his tennis career,[23] being diagnosed in 2005 at age 19.[24] He put off surgery as long as he could.[25] He has successfully continued his career after having surgery in 2021, winning the 2022 Australian and French Opens, though continuing to play through pain.[2] In winning the French Open he had two numbing injections and anti-inflammatories before each of his seven matches[19] to alleviate the pain; he won the tournament playing on a numb foot. He said he would not do this again.[23] Regarding his injury:

I am not injured; I am a player living with an injury. It's something that is there, and unfortunately, my day by day is difficult, honestly. It's difficult for me to accept the situation sometimes.[2]

See also

References

  1. ^
    PMID 27145453
    .
  2. ^ a b c Roy, Neelabhra (13 May 2022). "What is Mueller-Weiss Syndrome, the foot injury Rafael Nadal suffers from?". www.sportskeeda.com. Archived from the original on 2022-05-13. Retrieved 2022-06-05.
  3. S2CID 242284155
    .
  4. ^
    S2CID 244495353. Archived
    from the original on 2022-02-05. Retrieved 2022-06-05.
  5. ^ Mueller-Weiss Syndrome [1] Archived 2022-06-05 at the Wayback Machine
  6. ^ a b "What is Mueller-Weiss Syndrome? Understanding Rafael Nadal's "Rare" and "Incurable" Foot Condition". Louisville Bones. 2022-02-25. Archived from the original on 2022-05-12. Retrieved 2022-06-05.
  7. ^ a b c d "Mueller-Weiss-syndrome | The Foot and Ankle Online Journal". Retrieved 2022-06-08.
  8. ^ a b c Maciera, Ernesto (March 1, 2004). "Mueller-Weiss Syndrome". Foot and Ankle Clinics. 9: 105–125. Archived from the original on June 5, 2022. Retrieved June 5, 2022.
  9. ^
    PMID 33269217
    .
  10. ^ "UpToDate". www.uptodate.com. Retrieved 2022-06-09.
  11. ^
    PMID 31613455
    , retrieved 2022-06-07
  12. PMID 22460748
    .
  13. S2CID 59305670
    .
  14. S2CID 30160194
    . Case 228
  15. PMID 3260727
    .
  16. ^ "Mueller–Weiss syndrome, A Topical Review" (PDF).
  17. ^
    S2CID 244495353
    .
  18. ^ a b Rezaee, Amir. "Mueller-Weiss syndrome (classification) | Radiology Reference Article | Radiopaedia.org". Radiopaedia. Retrieved 2024-02-19.
  19. ^ a b Prajwal Hegde (Jun 7, 2022). "Rafael Nadal seeks 'long-term' relief to fix his injuries | Tennis News - Times of India". The Times of India. Retrieved 2022-06-11.
  20. S2CID 233214015
    .
  21. ^ a b c Cadogan, Mike; Gomez, Aparicio (2020-11-04). "Mueller–Weiss disease". Life in the Fast Lane • LITFL. Retrieved 2022-06-06.
  22. ^ "What is Mueller Weiss disease?". ypsl. 2021-10-01. Retrieved 2022-06-06.
  23. ^
    ISSN 0362-4331
    . Retrieved 2022-06-07.
  24. ^ Russell, Lauren (2022-06-28). "Rafael Nadal: Star's 'rare' condition causing 'strange sensations' ahead of Wimbledon". Express.co.uk. Retrieved 2022-07-07.
  25. ^ Train, Rob (2022-06-05). "What is Müller-Weiss syndrome, Rafa Nadal's chronic injury in his left foot?". Diario AS. Retrieved 2022-06-07.
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