PMID- 32600969 OWN - NLM STAT- MEDLINE DCOM- 20210726 LR - 20210726 IS - 1460-9584 (Electronic) IS - 1268-7731 (Linking) VI - 27 IP - 5 DP - 2021 Jul TI - Radiographic analysis of Muller-Weiss disease. PG - 501-509 LID - S1268-7731(20)30119-3 [pii] LID - 10.1016/j.fas.2020.06.009 [doi] AB - BACKGROUND: The only classification of Muller-Weiss disease (MWD) is based primarily on Meary's talo-first metatarsal angle. It describes increasing sag of the medial longitudinal arch with greater degrees of compression and fragmentation of the navicular. Purportedly, the talar head pushes the subtalar joint into varus and drives the medial pole of the navicular medially, as it protrudes inferiorly and laterally. Its authors stipulated heel varus as a pre-requisite, coining the term 'paradoxical pes planus varus' to define heel varus and flatfoot as hallmark deformities of the condition. METHODS: We measured Meary's and Kite's talocalcaneal angles, heel offset, anteroposterior thickness of the navicular at each naviculocuneiform (NC) joint, medial extrusion of the navicular and calculated percentage compression at each NC joint in 68 consecutive feet presenting with MWD. Morphology and activity at the various peri-navicular joints were studied using SPECT-CT in 45 feet. RESULTS: Inverse relationships between Meary's angle and degree of navicular compression reach statistical significance at NC2 but not at NC3. Strong correlation exists between medial extrusion and percentage compression at NC2 and NC3. Medial extrusion is significantly greater on the affected side in unilateral cases and on the more compressed side in bilateral cases. Significant inverse relationships exist between Kite's angle and percentage compression at both NC2 and NC3 and degree of medial extrusion of the navicular. No correlation was detected between Kite's angle and either heel offset or Meary's angle. Varus heel offset was present in only 33% of cases. The combination of heel varus and negative Meary's angle was present in just 26% of cases, the commonest combination being heel valgus with sagging at 56%. CONCLUSION: Our findings confirm part of Maceira's hypothesized pathomechanism of MWD. Reductions in Kite's talocalcaneal angle confirm that lateral and inferior protrusion of the talar head causes increasing compression and medial extrusion of the navicular. However, such shift of the talar head does not always lead to heel varus. As such, we caution against universal advocacy of lateral displacement calcaneal osteotomy, as the heel is not always in varus in MWD. CI - Copyright (c) 2020 European Foot and Ankle Society. All rights reserved. FAU - Wong-Chung, John AU - Wong-Chung J AD - Department of Trauma & Orthopaedics, Altnagelvin Hospital, Glenshane Road, Londonderry BT47 6SB, Northern Ireland, United Kingdom; University of Ulster, Northern Ireland, United Kingdom. Electronic address: johnwong@doctors.org.uk. FAU - McKenna, Raymond AU - McKenna R AD - Department of Trauma & Orthopaedics, Altnagelvin Hospital, Glenshane Road, Londonderry BT47 6SB, Northern Ireland, United Kingdom. FAU - Tucker, Adam AU - Tucker A AD - Department of Trauma & Orthopaedics, Altnagelvin Hospital, Glenshane Road, Londonderry BT47 6SB, Northern Ireland, United Kingdom. FAU - Gibson, Desmond AU - Gibson D AD - Department of Trauma & Orthopaedics, Altnagelvin Hospital, Glenshane Road, Londonderry BT47 6SB, Northern Ireland, United Kingdom. FAU - Datta, Pallab AU - Datta P AD - Department of Trauma & Orthopaedics, Altnagelvin Hospital, Glenshane Road, Londonderry BT47 6SB, Northern Ireland, United Kingdom. LA - eng PT - Journal Article DEP - 20200618 PL - France TA - Foot Ankle Surg JT - Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons JID - 9609647 SB - IM MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Bone Diseases/*diagnostic imaging/surgery MH - Female MH - Flatfoot/*diagnostic imaging/surgery MH - Follow-Up Studies MH - Foot/diagnostic imaging MH - Foot Diseases/*diagnostic imaging/surgery MH - Humans MH - Male MH - Metatarsal Bones/*diagnostic imaging/surgery MH - Middle Aged MH - Osteotomy MH - Retrospective Studies MH - Single Photon Emission Computed Tomography Computed Tomography/*methods MH - Subtalar Joint/*diagnostic imaging/surgery MH - Tarsal Bones/*diagnostic imaging/surgery MH - Treatment Outcome MH - Young Adult OTO - NOTNLM OT - Classification OT - Metabolism OT - Morphology OT - Muller-Weiss disease OT - SPECT-CT OT - Talonavicular arthrodesis OT - Talonaviculocuneiform arthrodesis EDAT- 2020/07/01 06:00 MHDA- 2021/07/27 06:00 CRDT- 2020/07/01 06:00 PHST- 2019/12/09 00:00 [received] PHST- 2020/06/03 00:00 [revised] PHST- 2020/06/08 00:00 [accepted] PHST- 2020/07/01 06:00 [pubmed] PHST- 2021/07/27 06:00 [medline] PHST- 2020/07/01 06:00 [entrez] AID - S1268-7731(20)30119-3 [pii] AID - 10.1016/j.fas.2020.06.009 [doi] PST - ppublish SO - Foot Ankle Surg. 2021 Jul;27(5):501-509. doi: 10.1016/j.fas.2020.06.009. Epub 2020 Jun 18.