UNASSIGNED: To compare the effectiveness of talonavicular-cuneiform joint fusion with iliac bone grafting and without bone grafting in the treatment of Müller-Weiss diseases (MWD).
UNASSIGNED: The clinical data of 44 patients (44 feet) with MWD who received talonavicular-cuneiform joint fusion between January 2017 and November 2022 and met the selection criteria was retrospectively analyzed. Among them, 25 patients were treated with structural iliac bone grafting (bone grafting group) and 19 patients without bone grafting (non-bone grafting group). There was no significant difference ( P>0.05) in age, gender composition, body mass index, disease duration, affected side, Maceira stage, and preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) score, anteroposterior/lateral Meary angle, and Pitch angle between the two groups. Operation time, operation cost, and postoperative complications were recorded in the two groups. AOFAS and VAS scores were used to evaluate the function and pain degree of the affected foot. Meary angle and Pitch angle were measured on the X-ray film, and the joint fusion was observed after operation. The difference (change value) of the above indexes before and after operation was calculated for comparison between groups to evaluate the difference in effectiveness.
UNASSIGNED: The operation was successfully completed in both groups, and the incisions in the two groups healed by first intention. The operation time and cost in the bone grafting group were significantly more than those in the non-bone grafting group ( P<0.05). All patients were followed up. The median follow-up time was 41.0 months (range, 16-77 months) in the non-bone grafting group and 40.0 months (range, 16-80 months) in the bone grafting group. There was skin numbness of the medial dorsalis of the foot in 1 case, internal fixation stimulation in 2 cases, and pain at the iliac bone harvesting area in 1 case of the bone grafting group. There was skin numbness of the medial dorsalis of the foot in 1 case and muscle atrophy of the lower limb in 1 case of the non-bone grafting group. There was no significant difference in the incidence of complications between the two groups ( P>0.05). At last follow-up, the AOFAS scores of the two groups significantly improved when compared with those before operation, while the VAS scores significantly decreased, the anteroposterior/lateral Meary angle and Pitch angle significantly improved, and the differences were significant ( P<0.05). There was no significant difference in the change values of outcome indicators between the two groups ( P>0.05). There was no delayed bone union or bone nonunion in both groups, and joint fusion was achieved at last follow-up.
UNASSIGNED: In the treatment of MWD, there is no significant difference in effectiveness and imaging improvement of talonavicular-cuneiform joint fusion combined with or without bone grafting. However, non-bone grafting can shorten the operation time, reduce the cost, and may avoid the complications of bone donor site.
UNASSIGNED: 比较距舟楔关节融合术中髂骨植骨与不植骨治疗Müller-Weiss病（Müller-Weiss diseases，MWD）的临床疗效。.
UNASSIGNED: 回顾性分析2017年1月—2022年11月接受距舟楔关节融合术治疗且符合选择标准的44例（44足）MWD患者临床资料。其中25例术中行自体髂骨结构性植骨（植骨组），19例不植骨（未植骨组）。两组患者年龄、性别构成、身体质量指数、病程、侧别、Maceira分期以及术前美国矫形足踝协会（AOFAS）评分、疼痛视觉模拟评分（VAS）、正/侧位Meary角、Pitch角等基线资料比较，差异均无统计学意义（ P>0.05）。记录两组手术时间、手术费用及术后相关并发症发生情况；采用AOFAS评分、VAS评分评价患足功能及疼痛程度；基于X线片测量正/侧位Meary角以及Pitch角，术后观察关节骨性融合情况。计算上述指标手术前后差值（变化值）进行组间比较，评价疗效差异。.
UNASSIGNED: 两组手术均顺利完成，术后切口均Ⅰ期愈合。植骨组手术时间及手术费用均多于未植骨组，差异有统计学意义（ P<0.05）。患者均获随访，未植骨组随访时间16～77个月，中位时间41.0个月；植骨组为16～80个月，中位时间40.0个月。植骨组发生足背内侧皮肤麻木1例、内固定物刺激2例、髂骨取骨区疼痛1例，未植骨组足背内侧皮肤麻木1例、小腿肌肉萎缩1例；两组并发生发生率比较，差异无统计学意义（ P>0.05）。末次随访时两组AOFAS评分较术前提高、VAS评分下降，正/侧位Meary角以及Pitch角均改善，差异有统计学意义（ P<0.05）；上述指标变化值组间差异均无统计学意义（ P>0.05）。两组均无骨延迟愈合、骨不连发生，末次随访时均达到关节骨性融合。.
UNASSIGNED: 距舟楔关节融合术治疗MWD时，联合自体髂骨植骨或不植骨处理的临床疗效和影像学改善程度无明显差异。但不植骨处理可缩短手术时间及手术费用，并且可以避免因自体取骨引发的取骨供区并发症。.

OBJECTIVE: Müller-Weiss disease (MWD) is a challenging condition involving the perinavicular region in the initial stages and subsequently the entire foot in the later stages. The goal of this article is to describe the pathomechanics, clinical evaluation, and nonoperative and operative treatment, including a treatment algorithm, based on current evidence and the combined authors\' experience.
METHODS: We review the related articles and summarize the information about this condition.
RESULTS: A number of related articles reveal that the treatments should focus on the management of degenerative regions and deformity correction to restore normal foot alignment and provide pain relief.
CONCLUSIONS: This systematic review proposes a treatment algorithm that is comprehensive and practical to apply for the management of MWD.

UNASSIGNED: This study reported the individual surgical treatment of 12 cases with stage IV Müller-Weiss disease (MWD) according to CT/MRI examination.
UNASSIGNED: In total, 12 cases diagnosed with stage IV MWD in our hospital from 2015 to 2019 were included in the retrospective study. Relevant clinical outcomes were evaluated preoperatively and postoperatively.
UNASSIGNED: The follow-up results showed satisfactory outcomes in all cases. All the cases were presented with tenderness and chronic pain on the midfoot dorsum, and three cases were also presented with tenderness and pain on the lateral side of the midfoot, in which calcaneal cuboid arthritis was revealed by CT/MRI. The American Orthopedic Foot and Ankle Society (AOFAS) scores elevated from 62.5 ± 6.8 (range: 53-74) preoperatively to 95.3 ± 7.2 (range: 73-100) postoperatively (P < 0.005). The Visual Analog Scale (VAS) scores declined from 4.2 ± 0.9 (range: 3-5.5) preoperatively to 0.5 ± 0.3 (range: 0-2) postoperatively (P < 0.001). On the weight-bearing lateral view of the foot, the Tomeno-Méary angle (TM lat) changed from -11.2 ± 4.2 (range: -17.2 to -2.8) degrees preoperatively to -2.4 ± 3.9 (range: -10.2 to 5.2) degrees postoperatively (P < 0.001).
UNASSIGNED: The fusion of the talus-navicular joint and the adjacent affected joint provide good clinical outcomes. The CT/MRI scans are helpful to identify the adjacent joint arthritis and provide indications for individual treatment for Stage IV MWD.

UNASSIGNED: Conservative treatment is the first-line approach for Müller-Weiss disease (MWD). However, factors associated with the failure of conservative treatment have never been reported. Our objectives were to compare the differences in demographic and radiographic parameters between \"successful\" and \"failure\" conservative treatment in patients with MWD and identify descriptive factors associated with failure conservative treatment.
UNASSIGNED: We retrospectively reviewed 68 patients with MWD divided into 29 \"failure\" and 39 \"successful\" conservative treatment groups. Demographic characteristics, Foot and Ankle Outcome Score (FAOS), visual analog scale (VAS) scores for pain and walking disability, and radiographic parameters such as calcaneal pitch, lateral Meary, anteroposterior (AP) Meary angle, and talonavicular-naviculocuneiform arthritis were compared. Logistic regression analysis was performed to identify descriptive factors of failure conservative treatment. A P value <.05 was considered a statistically significant difference.
UNASSIGNED: We found more severe VAS pain and walking disability scores and FAOS for the pain, activities of daily living, and quality of life subscales in the failure group (P < .05). Regression analysis demonstrated 2 significant descriptive factors associated with failure conservative treatment: abducted AP Meary angle >13.0 degrees and radiographic talonavicular arthritis. No demographic characteristics were found to be associated with failure conservative treatment.
UNASSIGNED: Midfoot abduction (AP Meary angle, >13 degrees) and radiographic talonavicular arthritis were factors associated with failure conservative treatment in MWD and should be determined concurrently with the clinical severity. Classification systems for MWD should include these factors.
UNASSIGNED: Level III, retrospective comparative study.

BACKGROUND: The only classification of Müller-Weiss disease (MWD) is based primarily on Méary\'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 Méary\'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 Méary\'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 Méary\'s angle. Varus heel offset was present in only 33% of cases. The combination of heel varus and negative Méary\'s angle was present in just 26% of cases, the commonest combination being heel valgus with sagging at 56%.
CONCLUSIONS: 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.

暂无摘要。

UNASSIGNED: Müller-Weiss disease (MWD) remains a controversial painful foot condition without consensus on its pathogenesis or a gold standard treatment modality. The aim of the study was to evaluate the outcomes of calcaneal lengthening in adolescent patients with symptomatic MWD with flatfoot.
UNASSIGNED: The study included 13 feet of 7 patients including 5 females and 2 males who were treated from March 2012 until June 2015 by calcaneal lengthening. The mean age was 15.6 years. The mean duration of symptoms was 13.5 months. The body mass index (BMI) averaged 28.9 kg/m2 at presentation. The patients were followed up for a mean of 37.8 months.
UNASSIGNED: The osteotomy healed in all cases after a mean of 7.2 weeks. The second foot was operated on after an average of 11.5 months. The mean talometatarsal-1 angle improved from 39.8 degrees preoperatively to 5.9 degrees. The mean preoperative calcaneal pitch angle of 7.5 degrees increased to an average of 17.8 degrees postoperatively. The mean American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Score was improved from 61.9 preoperatively to 94.2 postoperatively. Four patients had occasional exertional pain. Four feet had mild residual forefoot abduction. Arthrodesis was not needed in any case by the last follow-up.
UNASSIGNED: Early diagnosis of MWD with flatfoot was important and allowed for nonfusion treatment options. Calcaneal lengthening osteotomy in selected MWD cases achieved satisfactory outcomes with pain control, deformity correction, and improvement of the functional results.
UNASSIGNED: Level IV, retrospective case series.

UNASSIGNED: Various operative procedures have been reported for the treatment of Müller-Weiss disease (MWD). This study reports the midterm operative treatment results for stages II to V MWD with derotation of the talus and arthrodesis.
UNASSIGNED: Thirty-four patients (36 feet) with MWD were treated by talonavicular (TN) or talonavicular-cuneiform (TNC) arthrodesis in our center from 2008 to 2015. The affected feet were staged according to the Maceira staging system (stage II: 9; stage III: 10; stage IV: 9; stage V: 8). The American Orthopaedic Foot & Ankle Society (AOFAS) midfoot scale, the visual analog scale (VAS), and relative radiologic parameters were evaluated preoperatively and also during follow-up. The mean follow-up duration was 38.2 (range, 25-113 months).
UNASSIGNED: The final follow-up showed satisfactory outcomes. Overall, the AOFAS scores improved from 41.5 (range, 20-56) to 85.3 (range, 68-100) points ( P <.001), and the VAS score decreased from 5.7 (range, 3-8) to 0.9 (range, 0-4) points ( P <.001). The Tomeno-Méary angle decreased from -6.7 (range, -26.4 to 17.7) to 0.7 (range, -5.3 to 7) degrees ( P=.001). The calcaneal pitch angle increased from 13.7 (range, 4.1-26.2) to 22.0 (range, 13.3-28.9) degrees ( P < .001). The anteroposterior (AP) talar-first metatarsal angle decreased from -15.8 (range, -30.1 to -13.7) to -7.0 (range, -25.9 to -8.9) degrees ( P < .001), and the AP talocalcaneal angle increased from 14.7 (range, 4.7-22.3) to 22.1 (range, 13.4-29.5) degrees ( P=.005). The AP talonavicular coverage angle decreased from -27.0 (range, -40.4 to -13.3) to -7.8 degrees (range, -20.7 to -1.8) degrees ( P < .001).
UNASSIGNED: The midterm results found that the TN or TNC joint fusion could achieve a favorable clinical and radiologic outcome for patients with MWD. Even for the patients with severe deformities (stages IV-V), this treatment strategy could also achieve satisfactory deformity correction and functional improvement. Intraoperative restoration of talus rotation was the key to normal alignment of the subtalar joint/TN joint.
UNASSIGNED: Level IV, retrospective case series.

To investigate the short-term effectiveness of talonavicular joint arthrodesis and calcaneus osteotomy in the treatment of Müller-Weiss disease.
Between June 2015 and February 2017, 14 patients diagnosed Müller-Weiss disease, who were ineffective on conservative treatment, were treated with talonavicular joint arthrodesis and calcaneus osteotomy. There are 3 males and 11 females, with an average age of 46.2 years (range, 35-56 years). According to the Maceira grading criteria, 5 patients were rated as stage Ⅲ and 9 patients as stage Ⅳ. The disease duration ranged from 4 to 12 years (mean, 7 years). Preoperative X-ray films showed that all patients were not accompanied with adjacent joint arthritis. The hindfoot axis on Saltzman view was (9.8±2.8)°, calcaneal pitch angle (CPA) on lateral position was (14.7±5.1)°, Meary angle on lateral position was (4.8±2.8)°, and talar 1 meta-tarsal angle (T1MA) on anteroposterior position was (25.0±7.3)°. Preoperative visual analogue scale (VAS) score was 5.9±1.5, American Orthopedic Foot Ankle Society (AOFAS) ankle-hindfoot score was 58.8±17.6.
All patients were followed up 14-27 months (mean, 22.3 months). Medial numbness and incision infection occurred in 2, 2 cases, respectively. The other patients had no obvious discomfort. At last follow-up, VAS score was 1.6±1.3 and AOFAS score was 90.6±2.7, showing significant differences when compared with preoperative ones ( t=8.18, P=0.00; t=-6.95, P=0.00). X-ray films showed that the talonavicular joint and calcaneus osteotomy achieved bony healing. The hindfoot axis on Saltzman view was (-2.5±2.7)°, CPA on lateral position was (25.0±5.2) °, Meary angle on lateral position was (2.6±2.1)°, T1MA on anteroposterior position was (8.1±3.8)°. There was no significant difference in Meary Angle between pre- and post-operation ( t=1.53, P=0.15). And there were significant differences in the hindfoot axis, CPA, and T1MA between pre- and post-operation ( t=11.93, P=0.00; t=-8.89, P=0.00; t=8.05, P=0.00).
For Müller-Weiss disease patients without adjacent joint arthritis, who are ineffective on conservative treatment, the satisfied short-term effectiveness can be obtained when treated by talonavicular joint arthrodesis and calcaneus osteotomy.
探讨距舟关节融合联合跟骨截骨治疗 Müller-Weiss 病的早期疗效。.
2015 年 6 月—2017 年 2 月，对 14 例（14 足）保守治疗无效的 Müller-Weiss 病患者行距舟关节融合联合跟骨截骨治疗。男 3 例，女 11 例；年龄 35～56 岁，平均 46.2 岁。左足 6 例，右足 8 例。Maceira 分期：Ⅲ期 5 例，Ⅳ期 9 例。病程 4～12 年，平均 7 年。术前摄 X 线片测量 Saltzman 位后足力线为（9.8±2.8）°，侧位跟骨倾斜角（calcaneal pitch angle，CPA）为（14.7±5.1）°，侧位距骨第 1 跖骨角（Meary 角）为（4.8±2.8）°，正位距骨第 1 跖骨角（talar 1 meta-tarsal angle，T1MA）为（25.0±7.3）°；无邻近关节骨关节炎。术前疼痛视觉模拟评分（VAS）为（5.9±1.5）分，美国矫形外科足踝协会踝与后足评分（AOFAS）为（58.8±17.6）分。.
患者均获随访，随访时间 14～27 个月，平均 22.3 个月。术后 2 例出现足内侧麻木感，2 例切口感染；其余患者无明显不适。末次随访时，VAS 评分为（1.6±1.3）分，AOFAS 评分为（90.6±2.7）分，均较术前明显改善（ t=8.18， P=0.00； t=–6.95， P=0.00）。X 线片复查示，患者距舟关节及跟骨截骨均达骨性愈合；测量 Saltzman 位后足力线为（–2.5±2.7）°，侧位 CPA 为（25.0±5.2）°、Meary 角为（2.6±2.1）°，正位 T1MA 为（8.1±3.8）°；除 Meary 角与术前比较差异无统计学意义（ t=1.53， P=0.15）外，Saltzman 位后足力线、CPA、T1MA 与术前比较差异均有统计学意义（ t=11.93， P=0.00； t=–8.89， P=0.00； t=8.05， P=0.00）。.
对于保守治疗无效且无邻近关节骨关节炎的 Müller-Weiss 病患者，采用距舟关节融合联合跟骨截骨治疗可获得较好的早期疗效。.

Müller-Weiss disease (MWD) is a dysplasia of the tarsal navicular. The shifting of the talar head laterally over the calcaneus drives the subtalar joint into varus. Failure to identify patients with paradoxic flatfoot varus may lead to the incorrect diagnosis and management. Conservative treatment with the use of rigid insoles with medial arch support and a lateral heel wedge is effective in most patients. Dwyer calcaneal osteotomy combined with lateral displacement seems to be a satisfactory treatment for patients who had failed to respond to conservative measures and a good alternative to the different types of perinavicular fusions.