Mueller-Weisse Disease - Causes, Diagnosis, and Treatment

Introduction

Mueller-Weisse Disease, also known as Brailsford disease, is an orthopedic condition affecting the navicular bone of the foot. The first case of Mueller-Weisse Disease was reported in 1927 by an orthopedic surgeon named Walther Mueller. Later in 1929, two more cases were reported by an Austrian radiologist named Konrad Weisse. Hence the disease was named after them. The cause and the pathogenesis of this condition remain debatable. Deformities of the midfoot and posterior region of the foot characterize the condition. This article will discuss Mueller-Weisse Disease, its causes, symptoms, diagnosis, and treatment options in detail.

What Are the Anatomical Considerations?

Mueller-Weisse Disease affects the navicular bone of the foot. In general, the foot comprises 26 bones and 33 joints.

• The navicular bone is a small wedge-shaped bone in the middle of the joint. They help connect the ankle bones to the tarsal bones (seven bones that form the bony framework of the foot) of the foot.

• They provide stability to the arch of the foot and the ankle. It aids in the dynamic biomechanics of walking.

• Most portions of the navicular bone lack proper blood supply.

• This bone is referred to as the keystone bone of the foot since it bears most of the body's weight. This makes them more prone to fractures caused by stress and osteonecrosis (a condition that occurs due to reduced blood supply to a part of the bone resulting in the death of bone tissues).

What Is Mueller-Weisse Disease?

Mueller-Weisse Disease is a complex condition of the foot with an unknown cause characterized by the navicular bone's collapse and fragmentation followed by an early onset of degenerative changes in the adjacent joints of the navicular bone. This condition often causes pain and deformities of the mid and hindfoot. They occur commonly among females between the ages of 40 to 60. However, cases with Mueller-Weisse Disease below 18 have also been reported. It is a progressive condition of the foot that worsens over time. The collapse of the navicular bone results in a flat foot or a disfigured foot.

What Causes Mueller-Weisse Disease?

The exact cause of Mueller-Weisse Disease remains unclear. But, it is believed to occur due to a decrease in blood supply to the navicular bone of the foot. Loss of blood supply to the navicular bone (ischemia) is believed to occur for various reasons. Some common causes of reduced blood supply are mentioned below.

• Habits of smoking and alcohol consumption.

• Use of corticosteroids.

• Rheumatologic disorders (autoimmune disorders where the body's immune system affects its tissues and organs).

• Metabolic disorders (disorders that affect the body's metabolism and disrupt the body's ability to turn food into nutrients and excretion of waste).

• Hematologic disorders (disorders that affect the blood cells such as the red blood cells, white blood cells, and platelets).

• Obesity (overweight).

Other common causes of Mueller-Weisse Disease include chronic repetitive stress over the navicular bone, delay in the ossification (the process of bone formation) of navicular bone during embryonic development, congenital disabilities, and osteonecrosis of the navicular bone of the foot.

What Are the Symptoms of Mueller-Weisse Disease?

Common symptoms of Mueller-Weisse Disease include the following.

• Chronic and progressive pain over the posterior and midfoot region.

• Difficulty with walking.

• Foot swelling.

• Stiffness of the joint.

• Restriction in the foot movements.

• Positional foot deformities.

• Pain over the foot arch.

How Is Mueller-Weisse Disease Diagnosed?

A Mueller-Weisse Disease is diagnosed through detailed history taking and thorough clinical examination. A proper physical appraisal is necessary to rule out other differential diagnoses, such as flat feet deformity and conditions due to trauma, secondary osteonecrosis, and an undiagnosed stress fracture. An effective diagnosis is made through a radiographic investigation such as X-rays, MRI (magnetic resonance imaging), and CT (computed tomography).

Mueller-Weisse Disease may occur in both feet or unilaterally, and associated pathologic fractures may accompany it.

• Plain radiography is performed, such as the weight-bearing X-rays with multiple views, such as the anteroposterior, oblique, and lateral view of the foot and anteroposterior and lateral view of the ankle.

• The plain radiographs may show findings such as flattened navicular bone comma-shaped navicular bone, which occurs due to the collapse of the lateral part of the bone.

• Other findings may be seen, such as wedging and compression of the navicular bone or protrusion of the medical or dorsal portion of the navicular bone.

• CT scan promotes assessment of foot deformities, bone density, fractures, and associated arthritis.

• Based on the radiologic findings of the lateral radiographs, Mueller-Weisse Disease was classified into five stages by Macheira and Rochera in the year 2004.

• The classification includes;

  • Stage 1 (Mild): With minimal bone changes,

  • Stage 2 (Moderate): With the foot arch higher than normal and dislocation of the talar head that articulates with the navicular bone.

  • Stage 3 (Moderate): With overpronation of the foot.

  • Stage 4 and Stage 5 (Severe): With degenerative changes of the subtalar joint (the joint that connects the talus and calcaneus bone of the foot).

How Is Mueller-Weisse Disease Treated?

As of now, there is yet to be a proper treatment strategy for Mueller-Weisse Disease. However, In the earlier stages of the condition, the clinician may suggest conservative treatment options to improve the quality of life in these patients. Traditional treatment options include:

• Ankle Foot Orthoses: A patient-specific assistive device that protects and supports the ankle and foot.

• Cast Immobilization: A temporary casting in the ankle and the foot to keep the foot immobilized.

• NSAIDs: Non-steroidal anti-inflammatory drugs.

• Orthotics: A specially designed patients specific shoe inserts that support the foot and improve the posture.

An ultimate management option to treat Mueller-Weisse Disease is surgical intervention. Surgical management is generally considered when the conservative treatment option fails to improve even after six months. They are typically recommended in patients with stages 3, 4, and 5 of Mueller-Weisse Disease.

Management of Mueller-Weisse Disease includes various professionals such as ankle and foot specialist surgeons, radiologists, physical therapists, and rehabilitation specialists. There are different surgical procedures for Mueller-Weisse Disease, and they are performed based on the radiographic findings of the patient. Generally, the surgical procedure involves surgical removal of loose bone fragments, surgical internal fixation of the navicular bone, and surgical joint fusion.

Conclusion

Mueller-Weisse Disease is a rare orthopedic condition that causes deformities of the navicular bone of the foot. The underlying cause of the condition is unknown. The common symptoms of Mueller-Weisse Disease include severe pain in the midfoot and posterior region of the foot. Diagnosing this can be difficult due to their similarities with associated conditions. This condition is managed through conservative treatment options and rarely requires surgical treatment.