Osteonecrosis of the adult foot navicular

  In 1927 the German surgeon Walther-Müller reported a case of bilateral navicular deformity of the foot, which he considered a congenital defect, and in 1929 the Austrian radiologist Konrad-Weiss found two patients with a similar presentation, which he considered a form of osteonecrosis. The etiology of this disease has been controversial and the disease is currently named after both of them and is referred to as Müller-Weiss disease. It is a rare clinical condition of osteonecrosis of the adult foot navicular, characterized by chronic pain in the medial dorsum of the foot without a cause, compression and fragmentation of the navicular bone and progressive deformity of the hindfoot. In the later stages, it is unable to stand and walk for long periods of time, with loss of foot function and the appearance of a flat foot with inversion deformity of the hindfoot, marked pressure pain in the navicular area, and bony prominence in the dorsolateral and/or medial metatarsal aspect of the talocrural joint.  In stage 1, there is an undetectable inversion of the subtalar joint, with normal or slightly altered X-rays, positive findings on bone scan and CT, and intraosseous edema on MR; in stage 2, there is inversion of the subtalar joint, with a high arch of the foot, the Meary angle pointing to the dorsal side of the foot, the talar head is subluxed to the dorsal side of the foot, the tarsal canal and tarsal sinus show hole-like images, and the overlap area between the talar head and the heel bone prominence is reduced; in stage 3, the arch of the foot begins to The distance between the talar head and the cuneiform bone is obviously reduced; in stage 4, the hindfoot is obviously inwardly turned, the arch is obviously reduced, the talar bone is further compressed, and the Meary angle points to the bottom of the foot; in stage 5, the talar bone is completely extruded, forming a “talocuneiform joint”. The foot navicular is completely extruded and forms the “talocuneiform joint”.  The specialist needs to treat the patient individually according to the different stages in order to preserve the function of the joint and improve the patient’s symptoms to the maximum extent.