Tibial Stress Reaction

Muller-Weiss or avascular necrosis of the navicular in the adult was described as characterized by collapse and deformity of the navicular bone with secondary dorsal extrusion of a frament, as well as a resultant comma-shaped morphology of the navicular.

Although an attractive description to a familiar radiographic appearance, the navicular bone has a rich vascular supply from the dorsalis pedis and the sinus tarsi artery with a radial distribution within the bone. Therefore, it unlikely that spontaneous or post-traumatic AVN truly represents a separate entity. It is more plausible that the spectrum of change seen with the so-called Muller-Weiss syndrome are part of stress phenomena, and the extruded fragments represent stress fractures that become displaced.


Sclerotic and slightly collapsed lateral aspect of the navicular bone with a comma-shaped extruded fragment noted on the sagittal reconstructed scan.