Weekly Case

Title : case 361

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.

(Quiz
quiz 뿐이오니 답안은 한개만 보내주시기 바라오며, 복수의 답안을 보내주시는 분은 정답이 포함되어 있더라도 부득이 semi-correct answer 처리토록 하겠습니다.)


 


 


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


 


 


Diagnosis:

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



Correct Answer
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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