Müller-Weiss syndrome

Last revised by Daniel J Bell on 15 Apr 2024

Müller-Weiss syndrome, also known as Brailsford disease 3, refers to spontaneous multifactorial adult onset osteonecrosis of the 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 midfoot and hindfoot pain and pes planovarus.

Plain radiographic features can include:

  • comma-shaped deformity due to the collapse of the lateral portion 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.

The disease can be staged radiographically.

  • sclerosis with comma-shaped deformity of the lateral aspect

  • more advanced cases demonstrate further collapse and fragmentation


    • bone marrow edema is seen as hyperintensity on these fat-suppressed fluid-sensitive sequences

    • highly sensitive to early changes due to its ability to detect marrow signal changes

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.

Schmidt reported the first case in 1925. However, Walther Müller (1888) was the first to propose that the pathophysiology was due to an abnormal compressive force upon the ankle or a congenital abnormality. Konrad Weiss (1891) concluded that the appearances on plain film were analogous to those seen with Kienböck disease, i.e. an osteonecrotic etiology.

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