Müller-Weiss disease: Four case reports

Table 1 Radiological features in Müller-Weiss disease, described by Welck et al[10]

Radiological features in Müller-Weiss disease
Anteroposterior weightbearing
Hindfoot
Talocalcaneal divergence (reduced Kite angle)
Short cyma line: Talar head is no longer than the anterior process of the calcaneus
Widened talar head due to rotation
Midfoot
Comma or hourglass-shaped navicular
Lateral compression of the navicular with hyperdensity
Difficulty in distinguishing the lateral navicular from the underlying cuboid
Contact between the talar head and lateral cuneiforms
Medial column shortening
Cuboid sign: Subluxation of the cuboid
Forefoot
Parallelism of metatarsals with variable atrophy of 1st, 3rd, 4th and 5th
Second tarsal-metatarsal joint rotation
True or apparent (due to shortening of medial column) 1st metatarsal shortening
Second metatarsal cortical hypertrophy related to increased load
Lateral weightbearing
Hindfoot
Sinus-tarsi “see-through” sign
Increased calcaneal pitch
Abnormal cyma line
Posterior and middle subtalar facet visible in the same view
Double talar dome shadow
Midfoot
Anteroposterior shortening of the navicular
Meary’s line
Splitting with extrusion of the navicular
Surrounding arthritis

Table 2 Radiological staging by Maceira and Rochera[5]

Radiological staging
Stage 1	Normal or minimal bone changes on radiographs. Subtle subtalar varus. Intra-osseus edema on MRI. Positive CT scan
Stage 2	Initial cavovarus: Subtalar varus and dorsal angulation of Meary’s line, dorsal and lateral subluxation of the talar head
Stage 3	Subtalar varus. Medial column shortened. Neutral Meary’s line
Stage 4	Subtalar varus. Plantarwards Meary’s line. Paradoxical pes planus with varus and calcaneal equinus
Stage 5	Degeneration of the subtalar joint. Formation of talo-cuneiform articulation, complete extrusion of the navicular

MRI: Magnetic resonance imaging; CT: Computed tomography.