Muller-Weiss syndrome: treatment, what to do about this foot injury?

Tennis player Rafael Nadal, currently at Roland-Garros, has Muller-Weiss syndrome. Spontaneous osteonecrosis of the navicular bone, another name for this disease, is a very rare condition that causes foot pain. What is the best treatment? When to have surgery? Answers with Dr. Marc Elkaim.

[Mis à jour le 1er juin 2022 à 11h48] Muller-Weiss syndrome (pronounced “Muller Vaïce”) or Spontaneous osteonecrosis of the navicular (or scaphoid) bone is a very rare disease of foot. HAS 35 yearsthe tennis player Rafael Nadalwho just beat Novak Djokovic in the quarter-finals of Roland Garroshas this disease. “I don’t know what can happen after here, I have what I have at my feet. If we are unable to find a solution, this is going to be very difficult for me. […] Of course I will continue to fight to find a solution, but for the moment, we don’t have one. The last three and a half months have not been easy for me, that’s the only thing I can say. It’s not the time to talk about that, but I’m doing everything I can to try to play this tournament in the best possible conditions. I don’t know what can happen after honestlyyou“said the tennis player after his victory. From symptomsthe disease causes pains at foot level. The operation is considered when the treatments fail to cure this pathology. What is Muller-Weiss syndrome? What are the causes and the symptoms ? What treatment ? When to use the operation ? Answers with Dr. Marc Elkaim, orthopedic surgeon.

Diagram of the navicular or scaphoid bone
Diagram of the navicular or scaphoid bone ©

Definition: what is Muller-Weiss syndrome?

Muller-Weiss syndrome (or Mueller-Weiss) also called “spontaneous osteonecrosis of the navicular bone” is a very rare pathology of the foot. “She touches more women than men and is manifested by a compression of thenavicular bone between the talus and the lateral cuneiform bone, leading to spontaneous osteonecrosis (death of bone tissue, editor’s note) of the navicular bone“explains Dr. Marc Elkaim, orthopedic surgeon. This degenerative disease comes from Mueller’s 1927 description of the chronic deformity of the navicular bone in adults.

What are the causes of Muller-Weiss syndrome?

It’s a disease idiopathic that is, the causes are usually unknown. “But there are risk factors such as the back of varus foot. This malformation of the foot is manifested by theheel bone that tends to tuck in and increase pressure on the navicular bone. Furthermore, any constraint or significant pressure on this joint can aggravate the pathology by traumatic this already poorly vascularized bone” develops Dr. Elkaim.

What are the symptoms of Muller-Weiss syndrome?

The main and almost exclusive symptom is a foot pain localized on the dorsal side. “The foot can possibly inflate during the late phase of the disease but generally this pathology does not cause manyedema” indicates our expert. The patient will consult mainly for the pain.

How to diagnose Muller-Weiss syndrome?

It’s a disease difficult to diagnose at first. Once the patient describes their foot pain, the doctor prescribes a radiology of the foot. “The patient must be upright during the X-ray because the stress on the navicular bone is different depending on the position“says our interlocutor.

What are the treatments for Muller-Weiss syndrome?

The most common treatments are:

  • The orthopedic insoles in first proposal to decrease stress on the joints surrounding the navicular bone.
  • The catch anti-inflammatories.
  • Of the radio-guided infiltrations performed by a radiologist.
  • The surgery.

“Professional athletes often carry out infiltrations, but this treatment is feasible for a time but does not last over time. too many infiltrations damage the navicular bone which risks necrosis and it will be necessary to perform a bone graft“ warns Dr. Elkaim.

“The only surgery that works is arthrodesis”

When should you operate?

Surgical intervention is prescribed for patients for whom the treatments (rest, anti-inflammatories, insoles) are not enough to eliminate the pain. “Among the possible surgeries, the objective is to revascularize the bone. The only surgery that works is disabling, it’s arthrodesis (the fusion between the joints of the bones above and below). Once the navicular bone is dead, it fragments and can be expelled from the foot which will require a bone graft” supports the specialist. “The articulation of the navicular bone is responsible for adapting the foot to the terrain on which it walks. After an operation, some patients compensate with the other joints and use their feet normally. others develop a swaying gait“says the orthopedic surgeon.

Can Muller-Weiss syndrome be prevented?

“The Orthopedic sole prevent the aggravation of the disease if there is a deformity of the foot. We can also correct the varus of the rear foot surgically by breaking the heel bone to realign it and decrease pressure on the navicular bone” replies the specialist. On the other hand, the sport tends to make symptoms worse of a varus foot. “It is possible to play sports if there is no pain but do not force if you have pain.

Thanks to Dr Marc Elkaim, orthopedic surgeon.

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