The Treatment of Mueller-Weiss Disease: A Systematic Approach

Abstract

Mueller-Weiss disease (MWD), which involves dorsolateral fragmentation and collapse of the navicular, leads to functional misalignment and painful deformities. The successful treatment of MWD hinges on a detailed and through assessment of the patient to establish the modality of treatment that best suits the patient. In cases where operative management is indicated, proceeding to recreate a relatively pain-manageable (or where possible pain free), well-aligned, plantegrade foot is the goal. This can be performed technically by (1) determining as to which joints are involved/arthritic, and ensuring to address them; (2) establishing the amount of bone loss present, and planning to reconstitute this with graft material; (3) preparing the graft bed adequately and diligently to optimize the healing environment for the graft material; (4) providing a biomechanically sound treatment strategy that provides stability while the graft material heals; (5) and using orthopaedic principles while also remaining flexible. This is important because there is considerable variability in the anatomy and characteristics of MWD. Because of this, no single strategy is likely the “correct” method. Although the supporting literature remains sparse, when these principles are followed and postoperative complications can be avoided, significant improvements in function have been demonstrated and can be anticipated.

Level of Evidence: Diagnostic Level 5. See Instructions for Authors for a complete description of levels of evidence.