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.
This shouldn't be confused with Mallory-Weiss syndrome, which refers to a clinical syndrome caused by a mucosal and submucosal distal esophageal tear with involvement of the venous plexus.
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Epidemiology
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.
Radiographic features
Plain radiograph
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.
CT
sclerosis with comma-shaped deformity of the lateral aspect
more advanced cases demonstrate further collapse and fragmentation
MRI
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STIR/PDFS
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
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, 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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