Title : case 361 |
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Age / Sex : 59 / F Chief complaint: Pain around the left ankle joint and middle foot (Duration : 20 years ago) Courtesy: 이상민 (Sang Min Lee), 차의과학대학교 분당차병원 (Bundang Medical Center, CHA University) Diagnosis: Müller-Weiss syndrome DiscussionFindings: • 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 |
Correct Answer | |
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Name | Institution |
이름:소속병원 | |
Total Applicants: 16 | |
Correct answers:7 | |
김완태:중앙보훈병원 | |
강유선:서울대병원 | |
김현수:삼성서울병원 | |
박지원:대구튼튼병원 | |
길은경:순천향대부천병원 | |
홍원선:부민병원 | |
이상윤:무척나은병원 |
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