Surgical Outcomes in the Treatment of Mueller-Weiss Syndrome: A Systematic Review

Research Type: Level 5 - Case report, Expert opinion, Personal observation Introduction/Purpose: Mueller-Weiss syndrome is a rare condition that causes collapse of the medial aspect of the navicular bone, leading to midfoot pain, due to navicular osteonecrosis. Due to the progressive nature of the disease, conservative management is often insufficient, and surgical intervention becomes necessary to restore function and alleviate pain. This study evaluates surgical outcomes for Mueller-Weiss syndrome management, focusing on pain relief, functional improvement, and complications. Methods: A systematic search was conducted across PubMed, EMBASE, Scopus, Web of Science, and Cochrane databases to identify studies reporting outcomes following surgical treatment of Mueller-Weiss syndrome. Data were extracted on patient demographics, disease stage (Maceira classification), surgical techniques employed, and outcome measures (such as Visual Analog Scale [VAS] for pain and American Orthopaedic Foot and Ankle Society [AOFAS] scores). Results: A total of 25 studies were included, comprising 373 patients (391 feet), with a predominance of females (280) over males (75). Among studies reporting Maceira staging, most cases were classified as stage III (188 feet) or stage IV (125 feet), with fewer cases in stage I (1 foot), stage II (26 feet), and stage V (17 feet). The mean age was 52 years, with an average follow-up of 39 months. Surgical procedures included talonavicular arthrodesis (235 feet), talonavicular-cuneiform arthrodesis (94 feet), calcaneal osteotomy (32 feet), and combined talonavicular arthrodesis with calcaneal osteotomy (14 feet). Functional outcomes improved, with the mean VAS score decreasing from 6.9 preoperatively to 2 postoperatively, and the mean AOFAS score increasing from 42.2 to 83.3. The overall complication rate was 9.2%. Conclusion: The findings suggest that surgical treatment for Mueller-Weiss syndrome improves pain and function, with a notable reduction in VAS scores and a substantial increase in AOFAS scores. Talonavicular arthrodesis was the most commonly performed procedure, reflecting its role in stabilizing the midfoot. The majority of cases were advanced (stages III and IV), emphasizing the progressive nature of the disease and the necessity for surgical intervention in later stages. Further research is needed to determine the optimal surgical approach based on disease stage and patient-specific factors.