Radiographic Features

The diagnosis of Müller-Weiss diseaseMüller-Weiss disease rests on the finding of compression of the lateral part of the navicularNavicular giving it a comma-shaped or hour-glass appearance on weight-bearing plain radiographs. Its medial pole subluxes and extrudes medially while the talar head shifts laterally with resultant decrease in Kite’s angle. The second metatarsal is commonly longer than the first. Other radiographic signs are broken cyma linesCyma lines, striking parallelism of the metatarsals, hallucal sesamoids sitting in “too pretty” position, cuboid sign indicating medial subluxation at the calcaneocuboid jointCalcaneocuboid joint, an open sinus tarsi indicative of subtalar inversion and varying degrees of midfoot abductionMidfoot abduction. Méary’s angleMéary’s angle forms the basis for Maceira’s classificationMaceira’s classification, its end-stage V marked by formation of the talocuneiform articulationTalocuneiform articulation. Of the adjunctive imaging modalities, SPECT-CT isSPECT-CT preferable to MRI for studying arthritis of the various perinavicular jointsPerinavicular joints and remaining bone stock. The hindfoot alignment radiograph is useful for verifying heel position. One study found heel varusHeel varus in only 33%, heel varus together with flatfoot in 26%, the commonest combination being of heel valgus and flatfoot at 56%. Weight-bearing CT may prove useful in understanding why not all heels move into varus within the acetabulum pedis, when the talar head shifts laterally.