How to treat Müller-Weiss disease: A systematic review about the treatment algorithm

Müller-Weiss disease (MWD) is a complex pathology of the foot. Accompanied by navicular sclerosis, deformity, and osseous collapse, it leads to the destruction of the talonavicular (TN) joint. This review builds on and updates previous publications on Müller-Weiss disease, and compared with earlier systematic reviews the current study provides a systematic and PRISMA-based synthesis dedicated specifically to treatment outcomes and algorithms, including all available studies up to 2024. The aim of this systematic review was to answer the following questions: (1) what is the outcome depending on the treatment technique? (2) what is the treatment of choice depending on the stage of the disease? (3) what are the limitations and challenges in the current understanding and management of Müller-Weiss disease?

A systematic review was conducted according to the PRISMA 2020 guidelines. Pubmed and Google Scholar were used for a comprehensive search conducted using the keywords "Müller-Weiss" or "Mueller-Weiss" within the titles and abstracts of publications up until September 2023. Studies not presented in English, French, German, Italian, Spanish, or Portuguese were excluded. In total, 25 publications met the inclusion criteria and underwent further analysis. AOFAS Score was used to assess and compare the results of studies.

A variety of treatments were reported including nonoperative, joint sparing, and fusion procedures. Calcaneus osteotomy was reported in 3 studies (12%) and isolated percutaneous decompression was mentioned once as a treatment option. Arthrodesis emerged as the prevailing therapeutic approach, featuring in 80% of the studies (n = 20). The most frequent technique was a talonavicular-cuneiform arthrodesis for Maceira's stages III-V. We report a treatment algorithm adapted for the radiographic and clinical stage of the MWD.

MWD is a complex pathology that requires tailored management. Early diagnosis, accurate radiographic assessment and appropriate treatment are essential. Although there is no gold standard treatment, talo-navicular-cuneiform arthrodesis is emerging as one of the most effective options for deformity correction and symptom relief.

IV; Systematic Review.