Age / Sex : 59 / F

Chief complaint: Pain around the left ankle joint and middle foot (Duration : 20 years ago)

1) What is your impression?

Two weeks later, you can see the final diagnosis with a brief discussion of this case.

(Quiz는 quiz일 뿐이오니 답안은 한개만 보내주시기 바라오며, 복수의 답안을 보내주시는 분은 정답이 포함되어 있더라도 부득이 semi-correct answer로 처리토록 하겠습니다.)

Courtesy: 이상민 (Sang Min Lee), 차의과학대학교 분당차병원 (Bundang Medical Center, CHA University)

Müller-Weiss syndrome

Discussion

Findings:

•       loss of volume with increased radiodensity in lateral aspect of the navicula

•       dorsal protrusion with lateral collapse of the navicula

         →“Comma-shaped deformity”

•       secondary osteoarthritis of mid tarsal joint

•       secondary valgus deformity of hind foot

Differential Diagnosis:

•       Müller-Weiss syndrome with osteoarthritis in the midtarsal joint

•       Healed stress fracture with callus formation and osteoarthritis in the midtarsal joint

Diagnosis: Müller-Weiss syndrome

Discussion:

1) Clinical features

•       tarsal navicular collapse with chronic midfoot pain

         →  localized to dorsomedial aspect of tarsus

         →  weight–bearing activity

•       confused with Koehler’s disease

•       spontaneous osteonecrosis, most likely etiology

         →  precise mechanism remains unclear

         →  congenital malformation, osteochondritis, chronic stress fracture, or necrosis of traumatic or biomechanical origin

•       usually bilateral, predominant in women with ratio of 6:4

•       nonspecific, symptomatic therapy or surgical intervention

2) Imaging Features

•       loss of volume with increased radiodensity in lateral aspect of the navicula

•       dorsal protrusion and fragmentation with lateral collapse of the navicula

         →“Comma-shaped deformity”

•       homogeneously decreased intensity on T1-weighted image

•       secondary osteoarthritis of mid tarsal joint

•       secondary valgus deformity of hind foot and pes planus