926 - Diagnosing Müller-Weiss Syndrome: Correlating Physical Examination with Radiologic Findings

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

NE

Nicole Eckert, MD

Resident Physician
IU School of Medicine
Indianapolis, Indiana, United States

Co-Author(s)

CM

Christopher Moriarty, DO

Assistant Professor
Indiana University
Indianapolis, Indiana, United States

Submitter(s)

NE

Nicole Eckert, MD

Resident Physician
IU School of Medicine
Indianapolis, Indiana, United States

Case Diagnosis: Müller-Weiss Syndrome

Case Description: A 52-year-old Nigerian male presented to the PM&R clinic with 1 month of left posterior thigh pain following a fall. Physical examination was notable for bilateral claw toe deformities, somewhat truncated appearance of the midfoot, severe rigid pes planus, velocity-independent triceps surae hypertonia, and absence of Achilles deep tendon reflex. Workup for central neurological and neuromuscular etiologies was negative. XR bilateral ankle and foot were obtained and read as unremarkable by reviewing radiologist. However, after independent review and discussion with musculoskeletal radiology, a diagnosis of bilateral Müller-Weiss Syndrome was made.

Discussions: Müller-Weiss Syndrome is a rare cause of midfoot pain resulting from avascular necrosis of the tarsal navicular typically affecting adults in their 40s-50s. Although exact etiology is unknown, pathogenesis is likely multifactorial and related to chronic loading on a sub-optimally ossified navicular bone. Characteristic findings on radiographs include a comma shaped navicular with medial subluxation. Treatment is dependent on the radiological stage in which it is diagnosed and varies from pain control and orthoses to operative management. In addition to midfoot pain, progression of the navicular deformity eventually can lead to biomechanical changes affecting proximal musculoskeletal structures. In our patient’s case, these changes led to static stance and gait instability resulting in a significant fall. The combination of physical exam findings and unusual appearance of the tarsal navicular on radiographs led to discussion with musculoskeletal radiology regarding the possibility of bilateral Müller-Weiss Syndrome diagnosis.

Conclusions:

Müller-Weiss Syndrome is a rare cause of chronic midfoot pain and eventual deformity resulting from tarsal navicular osteonecrosis. In the absence of a dedicated musculoskeletal radiologist to review the study, this syndrome can easily be overlooked. Therefore, it is important for musculoskeletal physicians to keep this on the differential as the pain and deformity can further lead to altered biomechanics and disability if untreated.