Mueller Weiss syndrome, also known as Brailsford disease 3, refers to spontaneous multifactorial adult onset osteonecrosis of the tarsal navicular. This syndrome is distinct from Köhler disease, the osteonecrosis of the tarsal navicular bone that occurs in children.
It occurs in adults between 40 and 60 years of age and is more common in females. Patients present with mid- and hind foot pain and pes planovarus.
Plain radiographic features can include:
- comma-shaped deformity due to collapse of the lateral part of the bone
- medial or dorsal protrusion of a portion of the bone or the entire navicular bone
The disease may be bilateral or asymmetric and associated with pathologic fractures.
There is a radiographic staging.
- sclerosis with comma-shaped deformity of the lateral aspect
- more advanced cases demonstrate further collapse and fragmentation
- can show edema on STIR / PD FS images and is more sensitive in picking up the early changes due to its ability to detect marrow signal changes
Treatment and prognosis
The disease can be progressive at times, and it is associated with severe pain and disability. Initially, it is treated conservatively with analgesics and orthotics which if they fail then surgical treatment is considered.
History and etymology
Schmidt reported the first case in 1925. However W Muller was the first to propose that the pathophysiology was due to an abnormal compressive force upon the ankle or a congenital abnormality. K Weiss concluded that the appearances on plain film were analogous to those seen with Kienbock disease, i.e. an osteonecrotic etiology.
- 1. Rosenberg ZS, Beltran J, Bencardino JT. From the RSNA Refresher Courses. Radiological Society of North America. MR imaging of the ankle and foot. Radiographics. 2000;20 Spec No : S153-79. Radiographics (full text) - Pubmed citation
- 2. Haller J, Sartoris DJ, Resnick D et-al. Spontaneous osteonecrosis of the tarsal navicular in adults: imaging findings. AJR Am J Roentgenol. 1988;151 (2): 355-8. AJR Am J Roentgenol (abstract) - Pubmed citation
- 3. Samim M, Moukaddam HA, Smitaman E. Imaging of Mueller-Weiss Syndrome: A Review of Clinical Presentations and Imaging Spectrum. AJR Am J Roentgenol. 2016; W1-W11. doi:10.2214/AJR.15.15843 - Pubmed citation