Hetsroni Iftach, Nyska Meir, Ayalon Moshe
Orthopaedic Department, Meir Hospital, Sapir Medical Center, Tsharnichovski Street 59, Kfar Saba 44281, Israel.
Foot Ankle Int. 2007 Feb;28(2):237-41. doi: 10.3113/FAI.2007.0237.
Müller-Weiss disease (MWD) is a rare pathological entity of unclear etiology that occurs in middle aged individuals and is characterized by midfoot pain and typical radiographic findings of navicular compression between the talar head and lateral cuneiform. Pes planovarus is a hallmark of advanced disease. The purpose of this study was to characterize the plantar pressure distribution in patients with this diagnosis.
Eight symptomatic feet in six patients with MWD, between the ages of 40 and 60 years, were compared to 18 feet of nine normal individuals. Midfoot scores were recorded according to the American Orthopaedic Foot and Ankle Society scale. Radiographic staging of navicular fragmentation and talar head displacement was done according to the Meary-Tomeno lines. Plantar pressure was measured during walking on a level floor at a natural preferred cadence. All subjects used the same shoe model, and plantar pressure data were collected over four cycles. For each step, the mean pressure and mean normalized pressure impulse were calculated for each of 10 foot zones. The mean of the four steps was computed for comparison between groups. Statistical analysis was performed using a t-test, and the level of significance was set at 0.05.
All patients with MWD had advanced radiographic characteristics, and their midfoot scores did not exceed 47 points. Plantar pressure measurements demonstrated significantly higher values (p < 0.05) in the midfoot segments of patients with MWD than the control group, while significantly lower values (p < 0.01) were recorded in the toe segments.
Müller-Weiss disease is characterized by increased plantar pressures at the midfoot, combined with reduction in toe pressures. This abnormal pressure distribution may be at least partially responsible for patients' pain and discomfort. Considering these foot characteristics in treatment plans may help choose appropriate nonoperative treatment (i.e. insoles, arch support, hard platform shoes), as well as operative alternatives (appropriate fusion procedures).
米勒-魏斯病（MWD）是一种病因不明的罕见病理实体，发生于中年个体，其特征为中足疼痛以及距骨头与外侧楔骨之间舟骨受压的典型影像学表现。扁平足内翻是晚期疾病的一个标志。本研究的目的是描述该诊断患者的足底压力分布情况。
将6例年龄在40至60岁之间患有MWD的患者的8只患足与9名正常个体的18只足进行比较。根据美国矫形足踝协会量表记录中足评分。根据梅里-托梅诺线对舟骨碎裂和距骨头移位进行影像学分期。在水平地面上以自然偏好的步频行走时测量足底压力。所有受试者使用相同的鞋型，并在四个周期内收集足底压力数据。对于每一步，计算10个足部区域中每个区域的平均压力和平均标准化压力脉冲。计算四步的平均值以进行组间比较。采用t检验进行统计分析，显著性水平设定为0.05。
所有MWD患者均具有晚期影像学特征，且他们的中足评分不超过47分。足底压力测量显示，MWD患者中足节段的压力值显著高于对照组（p < 0.05），而趾节段的压力值显著低于对照组（p < 0.01）。
米勒-魏斯病的特征是中足足底压力增加，同时趾部压力降低。这种异常的压力分布可能至少部分导致了患者的疼痛和不适。在治疗方案中考虑这些足部特征可能有助于选择合适的非手术治疗方法（即鞋垫、足弓支撑、硬底平台鞋）以及手术替代方案（合适的融合手术）。
