Classification Systems

Maceira’s classificationMaceira’s classification depends solely on Méary’s angleMéary’s angle. Although it describes pathomechanics well, it bears no correlation with severity of symptoms and guides neither treatment nor prognosis. Its stage V, marked by a talocuneiform articulationTalocuneiform articulation, constitutes a reliable endpoint. Wong-Chung et al. based their grouping system on age of disease onset, a previous radiologically normal navicular, joints affected, dorsoplantar and lateral talo-first metatarsal angles. None of Wong Group 1 early-onset disease has required surgery yet. It has the greatest compression at the lateral naviculocuneiform (NC) joint, greatest medial extrusion and lowest Kite’s angle. All are index minus and have fracture at the lateral navicularNavicular, except one. Group 2 Müller-Weissoid feet had previously normal naviculars, on average 6 years earlier. Only talonavicular (TN) joint is involved in Group 3A. Both TN and NC joints are involved in Groups 3B and 3C. Group 3B, with TN > NC affection, has the highest incidence of Maceira stage V. Group 3C, also termed reverse Müller-Weiss diseaseMüller-Weiss disease, with NC > TN involvement has the greatest second metatarsal overlength and midfoot abductionMidfoot abduction. Combining Wong groups and Maceira stages should elucidate geographical differences in disease pattern and provide a common reporting platform towards achieving gold standards of treatment.