The indications and management of Müller Weiss disease with valgus calcaneus osteotomy

S. Li, M. Myerson, M. Monteagudo

Introduction: Müller Weiss disease (MWD) is characterized by lateral navicular necrosis which is associated with a varus alignment of the subtalar joint, varying degrees of arthritis of the talonavicular-cuneiform joints and a paradoxical flatfoot deformity in advanced cases. Although arthrodesis of the hindfoot is commonly used, we present the results of a previously unreported method of treatment using a calcaneus osteotomy incorporating a wedge and lateral translation.

Methods: Fourteen patients with MWD who were treated with a calcaneus osteotomy were retrospectively reviewed. There were seven females and seven males with an average age of 56 years (range 33-79), and included one grade 5, five grade 4, four grade 3 and four grade 2 patients. Patients had been symptomatic for an average of eleven years (range 1-14), and all underwent initial conservative treatment with an orthotic support that posted the heel into valgus. The primary indication for surgery was a limited but positive response to the use of the orthotic support, and a desire to avoid an arthrodesis of the hindfoot.

Results: Patients were followed for an average of three years following the procedure (range 1 - 7 years). Patients rated their pain on a visual analogue pain scale as an average of 8 (range 6-9) prior to surgery and an average of 2 postoperatively (range 0-4). The AOFAS scores improved from a mean of 29 (range 25 - 35) preoperatively to a mean of 79 (range 75-88) postoperatively. Hindfoot range of motion remained and the extent of arthritis of the navicular complex was unchanged. No patient has since required an arthrodesis.

Conclusion: Since the majority of MWD patients respond to an orthotic support which changes the load of the hindfoot and forefoot, we believed that patients would respond positively to a calcaneal osteotomy as an alternative treatment.