Mueller Weiss syndrome, a less elucidated and unusual cause of midfoot pain: A case report

Mueller Weiss Syndrome is a rare, under-diagnosed cause of chronic mid foot pain despite having well-described imaging features. It is historically described as spontaneous adult-onset osteonecrosis of the navicular bone. The disease commonly affects bilateral navicular bones in women in the fifth decade of life. Nearly a century after its first description as a disease entity, the exact etiopathogenesis is still not well understood. From a radiographic point of view weight-bearing radiographs of the foot remains the mainstay in diagnosis. Characteristic imaging findings include the lateral collapse of navicular, dorsomedial subluxation of the remnant navicular, and lateral deviation of the talus (hind-foot varus). Progressive disease leads to pes planus and secondary osteoarthritis of the talonavicular joint with or without the involvement of other midfoot joints. Severe disease may show “listhesis navicularis” and talo-cuneiform neo-articulation. Computed tomography and magnetic resonance imaging can be used as adjuncts, especially to detect changes in the initial stage of the disease and early osteoarthritic features.