Rafael Nadal: the last battle is against the Muller-Weiss Syndome

During his career, Rafael Nadal has done the impossible, winning 21 Grand Slams (none like him) including 13 Roland Garros, rewriting entire pages of tennis history. But Rafa has had to deal with a lot of injuries throughout his glorious career. The latest foot injury would be due to Muller-Weiss syndrome: a particular disease that could end his career.

Dr. Umberto Alfieri Montrasio, head of the foot and ankle specialist unit of the Galeazzi Orthopedic Institute in Milan, in an interview for Italian magazine Gazzetta Active, explained all the details of the Muller-Weiss Syndrome and what he can achieve for Rafael Nadal’s career.

He explained: “It is a degenerative pathology so rare that even in the scientific literature many publications are case reports or case histories of a few patients. Among the best known is a study from the 1950s with 56 cases and two studies by Maceira, of which the most recent and most important reported in the literature of 191 cases out of 101 patients in 2004.

When pain and difficulty in movement are felt, it is now late. Sometimes it is accompanied by a bump in the internal part of the Midfoot. Usually patients with Müller-Weiss have hollow feet, but this bump on the inside of the midfoot simulates a flat foot. Unfortunately, however, this symptom also appears late. We do not know the type of association between knee pain and Müller-Weiss syndrome, but some patients have been noted to have pain in the knees, possibly related to incorrect foot support.

Primitive osteonecrosis has been hypothesized, the origin of which is ig note, perhaps linked to poor blood circulation in the scaphoid, which is no longer vascularized. But post-traumatic osteonecrosis has also been hypothesized, perhaps after repeated microtraumas. Or a slowing down of the ossification process of the scaphoid. All bones, in fact, start from a cartilage phase and then, with growth, they ossify. In the case of Müller-Weiss syndrome there is a significant slowdown in the maturation process of the scaphoid. In the long term, the scaphoid, subjected to stress, loses its elasticity and fragments, collapses, dislocates. 

The most suitable therapy? Orthotics, suitable shoes. Sometimes a treatment with a pinstripe boot is done for analgesic purposes, and to contain the fracture of the scaphoid. Then there are physical and instrumental palliative therapies, infiltrations with anti-inflammatory and cortisone drugs. The surgery gives sufficient results, but with sacrifices: the joints linked to the tarsal scaphoid must in fact be blocked, with consequent important limitations in the mobility of the foot. You can then walk, swim, cycle, but I would avoid sports such as tennis, basketball, volleyball or rugby, which involve repeated foot trauma. 

What little is known is that, generally, it is more women, with an incidence of 70%, again according to the few studies conducted to date. average age of onset of Müller-Weiss syndrome is around 45 years, and more generally between 40 and 60. For this reason the case of Nadal is even more particular. The disease is characterized by the fragmentation and necrosis of the tarsal or navicular scaphoid which over the years leads to an arthritic process of those joints that rotate around the scaphoid itself.