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Mueller-Weiss Disease

Mueller-Weiss disease is a rare condition that affects the navicular bone, a small bone in the middle of the foot (Figure 1). It is named after W Mueller and K Weiss who helped describe this condition in the late 1920’s. Mueller-Weiss disease occurs when the navicular bone weakens and collapses. This can lead to talonavicular arthritis with resulting pain and difficulty walking. The disease is thought to occur because of poor blood supply to the navicular bone, leading to its gradual damage. It is more likely to happen in adults, especially those between 40 and 60 years old, and is more common in women. Risk factors include having flat feet, being overweight, or putting too much stress on the feet over time.

Diagram illustrating the location of navicular bone
Figure 1: Location of navicular bone

Diagnosing Mueller-Weiss Disease

Mueller-Weiss disease is diagnosed by looking at a person’s symptoms, medical history, and images of their foot. A doctor will ask about foot pain and check for tenderness or changes in the shape of the foot. Pain in the inside aspect of the midfoot is common. Some stiffness and loss of midfoot motion may be observed. These symptoms and exam findings are similar to those seen with talonavicular arthritis. The misshapen navicular bone often leads to talonavicular arthritis with resulting symptoms.

Weight-bearing x-rays of the foot will often allow the diagnosis of Mueller-Weiss disease to be made. X-rays will demonstrate a collapsed or deformed navicular bone. Often, the navicular bone is described as looking like a “comma”. X-rays will also allow the extent of talonavicular arthritis to be assessed.  A loss of joint space between the talus and navicular combined with the formation of nearby bone spurs signifies that there is notable talonavicular arthritis.  Sometimes, doctors may also use more detailed imaging tests, like an MRI or CT scan, to get a clearer picture of the damage and check for signs of reduced blood flow to the bone (avascular necrosis). These tests help confirm the diagnosis and plan treatment.

Treatment

Conservative Treatment of Mueller-Weiss Disease

Mueller-Weiss disease can often be treated conservatively without surgery by instituting strategies to relieve pain and protect the foot from more damage. The goal of treatment is to make walking easier and prevent the condition from getting worse. Conservative treatment of Mueller-Weiss disease is similar to treatment for talonavicular arthritis and other arthritic joints in the foot and lower leg and includes:

  • Activity Modification: Limiting standing and walking will limit the amount of repetitive force that goes through the foot each day. This in turn will tend to decrease the pain originating from the affected area of the foot.
  • Comfort Shoes: A good shoe with a stiff sole, a rocker contour, and comfortable uppers can help limit the amount of force that the navicular and surrounding joints are exposed to with walking and standing. This usually lessens a patient’s pain and improves their function.
  • Orthotic Inserts: Soft supportive orthotics when combined with a good shoe can often improve symptoms in patients with Mueller-Weiss disease.
  • Anti-Inflammatory Pain Medication (NSAID): Provided that there are no contraindications non-steroidal anti-inflammatory drugs (NSAIDs) can help improve arthritis symptoms.
  • Physical Therapy: Exercises that work on gently mobilizing the foot while improving strength in the muscle that support the foot can be helpful.
  • Weight Loss: The foot acts as a level to magnify the force by 2-3x that is absorbed with each step. Therefore, if a patient is overweight losing even a bit of weight can help decrease their pain symptoms.
  • Corticosteroid Injections: In some patients an injection of corticosteroids into the arthritic talonavicular joint can result in considerable pain relief for several months. These injections are usually performed with the guidance of fluoroscopy or ultrasound to ensure that the injection is administered into the narrow talonavicular joint.

Surgical Treatment of Mueller-Weiss Disease

If conservative treatment of Mueller-Weiss disease does not adequately improve the pain and symptoms or the disease is severe, surgery might be needed. Typically, surgery to treat the talonavicular arthritis associated with Mueller-Weiss disease involves fusing the talonavicular joint. This surgery is designed to turn a stiff painful joint into a stiff painless joint. to fix or fuse the bones in the foot. The goal of treatment is to make walking easier and prevent the condition from getting worse.

November 25th, 2024

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