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Bai W, Xu J, Zhang H, Li X, Zou Y, Shen G, Zhu Y. Müller-Weiss Disease: Midfoot Arthrodesis in Reduction vs Malreduction. Foot Ankle Int 2024; 45:225-235. [PMID: 38385244 DOI: 10.1177/10711007231220911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
BACKGROUND Midfoot arthrodesis is regarded as the main surgical approach for treating Müller-Weiss disease (MWD). This study aimed to investigate the incidence of postoperative pain during MWD treatment through midfoot reduction or malreduction during arthrodesis and to explore the factors influencing postoperative pain in patients with MWD. METHODS A total of 67 patients with MWD were recruited and divided into two groups according to whether midfoot alignment was reduced: reduction group (n = 38) and malreduction group (n = 29). Demographic characteristics before the operation and at the last follow-up, as well as clinical and radiographic parameters, were compared between the two groups. Clinical parameters included the American Orthopaedic Foot & Ankle Society score and visual analog scale score, whereas radiographic parameters included the calcaneal pitch angle, lateral Meary's angle, talometatarsal-1 angle dorsoplantar (TMT1dp), talocalcaneal angle dorsoplantar (Kite angle), talonavicular coverage angle, and medial navicular pole extrusion. Postoperative complications and incidence of midfoot pain were evaluated at the last follow-up visit. RESULTS The reduction group exhibited better clinical and radiological parameters, including the TMT1dp and medial navicular pole extrusion, than the malreduction group at the last follow-up (all P < .05). However, the calcaneal pitch angle, lateral Meary's angle, Kite angle, and talonavicular coverage angle did not significantly differ between the two groups (all P > .05). The overall incidence of midfoot pain was 26.4%. The reduction group showed a lower incidence of medial pain than the malreduction group (15.7% vs. 40.0%, P < .05). Regression analysis revealed that midfoot abduction, represented by the TMT1dp, was a critical factor for midfoot arthrodesis failure and that medial navicular pole extrusion was not correlated with postoperative midfoot pain. CONCLUSION Midfoot reduction arthrodesis yields better clinical outcomes than malreduction arthrodesis. The TMT1dp, representing midfoot abduction, is a key factor for midfoot arthrodesis failure. The extruded medial navicular bone may not affect postoperative medial midfoot pain. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Wenbo Bai
- Department of Foot and Ankle Orthopedics, Foshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine, Foshan, Guangdong, China
| | - Jingcheng Xu
- Department of Foot and Ankle Orthopedics, Foshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine, Foshan, Guangdong, China
| | - Hongning Zhang
- Department of Foot and Ankle Orthopedics, Foshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine, Foshan, Guangdong, China
| | - Xue Li
- Department of Foot and Ankle Orthopedics, Foshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine, Foshan, Guangdong, China
| | - Yunxuan Zou
- Department of Foot and Ankle Orthopedics, Foshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine, Foshan, Guangdong, China
| | - Guodong Shen
- Department of Foot and Ankle Orthopedics, Foshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine, Foshan, Guangdong, China
| | - Yongzhan Zhu
- Department of Foot and Ankle Orthopedics, Foshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine, Foshan, Guangdong, China
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Molina WF, Nogueira MP, Alvo FS, Heitzmann LG. Müller-Weiss disease: a functional and quality of life assessment. INTERNATIONAL ORTHOPAEDICS 2023:10.1007/s00264-023-05851-5. [PMID: 37294430 DOI: 10.1007/s00264-023-05851-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 05/19/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE Evaluate the functional health status and quality of life of patients diagnosed with Müller-Weiss disease and, secondarily, determine the influence of factors such as gender, social status, race, body mass index, and surgical and non-surgical treatment in patient outcome. METHODS This study included 30 affected feet (18 patients) with follow-up from 2002 to 2016. Five patients were excluded from reassessment, resulting in 20 feet (13 patients). Questionnaires for functional and quality of life assessments were administered, and statistical analysis was performed. RESULTS Patients with obesity had poor functional results and low quality of life rates. Regarding quality of life, mainly in the mental health domain, there was a significant difference (p < 0.001) that was not observed in other domains investigated, except for surgical treatment, which was superior to non-surgical treatment in terms of the physical domain (p = 0.024). Bilateral treatment was also superior to unilateral treatment in Coughlin's classification (71.4% versus 66.7%). CONCLUSIONS Müller-Weiss disease evolved with poor functional results and low quality of life rates in patients with obesity, with no method of treatment influence on patient outcome, except for the SF-12 physical domain, where surgical treatment showed better results than conservative treatment.
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Affiliation(s)
- Wellington Farias Molina
- Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo (IAMSPE), Rua Pedro de Toledo, 1800- Vila Clementino, São Paulo, SP, 04039-000, Brazil
| | - Monica Paschoal Nogueira
- Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo (IAMSPE), Rua Pedro de Toledo, 1800- Vila Clementino, São Paulo, SP, 04039-000, Brazil.
| | - Fernando Salgueiro Alvo
- Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo (IAMSPE), Rua Pedro de Toledo, 1800- Vila Clementino, São Paulo, SP, 04039-000, Brazil
| | - Lourenço Galizia Heitzmann
- Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo (IAMSPE), Rua Pedro de Toledo, 1800- Vila Clementino, São Paulo, SP, 04039-000, Brazil
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Carrascoso J, Monteagudo M, Llopis E, Jiménez M, Recio M, Maceira E. Imaging of Müller-Weiss Disease. Semin Musculoskelet Radiol 2023; 27:293-307. [PMID: 37230129 DOI: 10.1055/s-0043-1766096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Müller-Weiss disease (MWD) is the result of a dysplasia of the tarsal navicular bone. Over the adult years, the dysplastic bone leads to the development of an asymmetric talonavicular arthritis with the talar head shifting laterally and plantarly, thus driving the subtalar joint into varus. From a diagnostic point of view, the condition may be difficult to differentiate from an avascular necrosis or even a stress fracture of the navicular, but fragmentation is the result of a mechanical impairment rather than a biological dysfunction.Standardized weight-bearing radiographs (anteroposterior and lateral views) of both feet are usually enough to diagnose MWD. Other imaging modalities such as multi-detector computed tomography and magnetic resonance imaging in early cases for the differential diagnosis can add additional details on the amount of cartilage affected, bone stock, fragmentation, and associated soft tissue injuries. Failure to identify patients with paradoxical flatfeet varus may lead to an incorrect diagnosis and management. Conservative treatment with the use of rigid insoles is effective in most patients. A calcaneal osteotomy seems to be a satisfactory treatment for patients who fail to respond to conservative measures and a good alternative to the different types of peri-navicular fusions. Weight-bearing radiographs are also useful to identify postoperative changes.
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Affiliation(s)
- Javier Carrascoso
- Department of Radiology, Hospital Universitario Quirónsalud Madrid, Faculty Medicine UEM Madrid, Madrid, Spain
| | - Manuel Monteagudo
- Orthopaedic Foot and Ankle Unit, Department of Orthopaedic and Trauma, Hospital Universitario Quirónsalud Madrid, Faculty Medicine UEM Madrid, Madrid, Spain
| | - Eva Llopis
- Orthopaedic Foot and Ankle Unit, Department of Orthopaedic and Trauma, Complejo Hospitalario La Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain
| | - Mar Jiménez
- Department of Radiology, Hospital Universitario Quirónsalud Madrid, Faculty Medicine UEM Madrid, Madrid, Spain
| | - Manuel Recio
- Department of Radiology, Hospital Universitario Quirónsalud Madrid, Faculty Medicine UEM Madrid, Madrid, Spain
| | - Ernesto Maceira
- Department of Radiology, Hospital de la Ribera, Alzira, Valencia, Spain
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Wong-Chung J, Walls A, Lynch-Wong M, Cassidy R, McKenna R, Wilson A, Stephens M. Towards understanding Müller-Weiss disease from an analysis of 95 cases. Foot Ankle Surg 2023:S1268-7731(23)00093-0. [PMID: 37225610 DOI: 10.1016/j.fas.2023.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/02/2023] [Accepted: 05/13/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND The single existing classification of Müller-Weiss Disease (MWD), based solely upon Méary's angle, serves neither as guide for prognosis nor treatment. This accounts for lack of gold standard in its management. METHODS Navicular compression, medial extrusion, metatarsal lengths, Kite's, lateral and dorsoplantar talo-first metatarsal angles were measured in 95 feet with MWD. Joints involved, presence and location of navicular fracture were recorded. RESULTS Group 1 "early-onset" MWD feet (n = 11) had greatest compression and medial extrusion, and lowest Kite's angles. All except 1 were index minus and had lateral navicular fracture. Only 1 had moderate degeneration at the talonavicular joint (TNJ) with none requiring surgery yet. Group 2 "Müller-Weissoid" feet (n = 23) had radiologically normal navicular in their fifties and developed MWD on average 5 years later. They had the lowest compression and extrusion, and highest Kite's angles. None had complete fracture. All had TNJ arthritis, with early changes at lateral naviculocuneiform joint (NCJ) in 43%. Group 3 "late-onset" MWD presented in the sixth decade. Only TNJ was involved in Group 3 A (n = 16). Group 3B (n = 20) affected TNJ more than NCJ and had the greatest number of Maceira stage V disease. Group 3 C "reverse Müller-Weiss disease", which affected NCJ more than TNJ (n = 25), had greatest midfoot abduction and overlength of the second metatarsal. No fracture occurred in group 3 A compared to 65% and 32% in groups 3B and 3 C, respectively. CONCLUSIONS With need to compare like-for-like pathology, the proposed classification provides a common platform for reporting outcomes of different treatments. We theorize pathogenetic pathways in the various groups.
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Affiliation(s)
- John Wong-Chung
- Department of Trauma & Orthopaedics, UK; University of Ulster, Altnagelvin Hospital, Glenshane Road, Londonderry BT47 6SB Northern Ireland, UK.
| | | | | | - Roslyn Cassidy
- Department of Orthopaedics, Musgrave Park Hospital, Stockman's Lane Belfast, UK
| | - Raymond McKenna
- Department of Orthopaedics, Musgrave Park Hospital, Stockman's Lane Belfast, UK
| | - Alistair Wilson
- Department of Orthopaedics, Musgrave Park Hospital, Stockman's Lane Belfast, UK
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Lu L, Liu B, Zeng J, Chen W, Hu F, Ma Q, Yu G. Efficacy of Triple and Talonavicular Arthrodesis for the Treatment of III-V Müller-Weiss Disease. TOHOKU J EXP MED 2022; 258:97-102. [PMID: 35896365 DOI: 10.1620/tjem.2022.j062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Liang Lu
- Department of Orthopedic Surgery, The First Affiliated Hospital of University of Science and Technology of China
| | - Bin Liu
- Department of Orthopedic Surgery, The First Affiliated Hospital of University of Science and Technology of China
| | - Jianxue Zeng
- Department of Orthopedic Surgery, The First Affiliated Hospital of University of Science and Technology of China
| | - Weijian Chen
- Department of Orthopedic Surgery, The First Affiliated Hospital of University of Science and Technology of China
| | - Feng Hu
- Department of Orthopedic Surgery, The First Affiliated Hospital of University of Science and Technology of China
| | - Qing Ma
- Department of Orthopedic Surgery, The First Affiliated Hospital of University of Science and Technology of China
| | - Guangrong Yu
- Department of Orthopedic Surgery, Tongji Hospital of Tongji University
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Liu W, Chen Y, Zeng G, Yang T, Ma M, Song W. Individual Surgical Treatment of Stage IV Müller-Weiss Disease According to CT/MRI Examination: A Retrospective Study of 12 Cases. Front Surg 2022; 9:694597. [PMID: 35372477 PMCID: PMC8968067 DOI: 10.3389/fsurg.2022.694597] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 01/26/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThis study reported the individual surgical treatment of 12 cases with stage IV Müller-Weiss disease (MWD) according to CT/MRI examination.MethodsIn total, 12 cases diagnosed with stage IV MWD in our hospital from 2015 to 2019 were included in the retrospective study. Relevant clinical outcomes were evaluated preoperatively and postoperatively.ResultsThe follow-up results showed satisfactory outcomes in all cases. All the cases were presented with tenderness and chronic pain on the midfoot dorsum, and three cases were also presented with tenderness and pain on the lateral side of the midfoot, in which calcaneal cuboid arthritis was revealed by CT/MRI. The American Orthopedic Foot and Ankle Society (AOFAS) scores elevated from 62.5 ± 6.8 (range: 53–74) preoperatively to 95.3 ± 7.2 (range: 73–100) postoperatively (P < 0.005). The Visual Analog Scale (VAS) scores declined from 4.2 ± 0.9 (range: 3–5.5) preoperatively to 0.5 ± 0.3 (range: 0–2) postoperatively (P < 0.001). On the weight-bearing lateral view of the foot, the Tomeno-Méary angle (TM lat) changed from −11.2 ± 4.2 (range: −17.2 to −2.8) degrees preoperatively to −2.4 ± 3.9 (range: −10.2 to 5.2) degrees postoperatively (P < 0.001).ConclusionsThe fusion of the talus-navicular joint and the adjacent affected joint provide good clinical outcomes. The CT/MRI scans are helpful to identify the adjacent joint arthritis and provide indications for individual treatment for Stage IV MWD.
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Affiliation(s)
- Wenzhou Liu
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yanbo Chen
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Gang Zeng
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tao Yang
- Department of Emergency, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Mengjun Ma
- Department of Orthopedics, The Eight Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Mengjun Ma
| | - Weidong Song
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Weidong Song
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