The question: what is the Muller-Weiss syndrome that Rafael Nadal suffers from?

Rafael Nadal is more than a great champion: he is a legend of tennis and sports in general. The man with 21 Grand Slam titles (it is a record, Roger Federer and Novak Djokovic are blocked at 20 which is already extraordinary), plays his 37th semifinal in a Major this Friday, the 15th at Roland-Garros. If the figures are dizzying, they become lunar when we know that the Spanish suffer from Muller-Weiss syndrome. “What he achieves is a feat: winning tournaments, being in the Grand Slam semifinals today with this pathology“, greets Dr. Hervé Collado, sports doctor at the Sainte-Marguerite Hospital in Marseille. For La Provence, he deciphers this disease: what is Muller-Weiss syndrome? How does it appear? What are the remedies? Deciphered.

What is the “Muller-Weiss” syndrome that Rafael Nadal suffers from?
Dr. Hervé Collado: It affects a particular bone in the foot called the scaphoid bone. It is a very important bone, which is located in the upper part in the middle of the foot approximately, which will be subject to osteonecrosis. It’s a bit like what might be called a bone “heart attack”. To be alive, a bone needs blood, several elements. There, it will lack vascularization. There is not enough blood for a heart attack and therefore there will be necrosis. The bone will atrophy and little by little it will fragment and end up being destroyed. It is osteonecrosis due to ischemia, therefore due to lack of blood supply.

This bone, we imagine, is essential for the movement of the foot…
It is a very painful syndrome because this bone has a strategic place in the foot. For support on the ground, it is part of this support. For Rafael Nadal it must be between 80 and 90 kg, it is extremely painful because that weight hurts on a bone that he is already suffering.

How can this injury arise?
There are several explanations. The first, the least satisfactory, is what is called idiopathic disease. Somehow we don’t know where this syndrome can come from. It comes like that, without really a cause. Second explanation, it affects patients who have a varus rear foot. The heel is slightly angled inwards. In fact, as the heel is not well oriented, it is “varus”, which causes forces on the scaphoid bone. It’s going to be compressed, too compressed between this heel and the front bones. It’s going to be a bit slow. This is where your suffering appears. You should also know that it is a syndrome that generally affects women.

“Infiltrations do not change the course of the disease, they will not revive the bone”

And how can we detect this disease?
Rafael Nadal must have felt pain taking his support. It is also pain when you just walk. They are located above the foot, sometimes visible with inflammation, so there are slightly red marks and a little heat. It is extremely inconvenient for all movements.

Rafael Nadal talks about unbearable pain…
It is such a strategic bone to absorb the forces of the foot. And the fact that it is gradually being destroyed creates the pain.

What are the solutions to treat this pathology?
It is quite very complicated. The first is the cessation of effort, rest. For Rafael Nadal, it is a bit difficult. Except when the pain is insurmountable. Then there is above all the use of soles. They will support the arch of the foot and support the pull-ups on it. It is also to adjust the malformations of the heel a little to modify the architecture of the foot so that the pressure is less strong on this bone.

Rafael Nadal resorted to infiltrations for his case…
It’s when the pain is too strong despite everything we’ve just seen. Infiltrations have an analgesic purpose, therefore against pain. It does not change the course of the disease, it will not reanimate the bone. So we inject corticosteroids, anti-inflammatories. In the case of Rafael Nadal, he participates in Roland-Garros, he has two weeks of effort. He will have less pain, we know he will not heal. The problem is that if you do too much it will become damaging to the bone and will accentuate the necrosis. We have to limit ourselves to infiltrations because if we don’t we are going to cause necrosis to break out, Muller-Weiss syndrome and it will end. It can get worse with too many.

And the last step to cure this syndrome?
It’s surgery! We’re going to do an arthrodesis. So let’s weld bones together. The navicular bone is trapped between two bones: the talus at the back and the cuneiform at the front. He is interspersed. This practice consists of completely blocking these three bones so that they no longer move and make the pain disappear. But normally between these three bones there is a joint to allow the foot to be flexible, if you are locked you will walk a little less well. The foot will be stiffer.

Could it end the Spanish career?
Of course. Support is complicated. I think that’s what can topple him over with insurmountable pain. When it is an advanced stage and we can imagine that in the case of Rafael Nadal he forced a lot, it is difficult to remedy it. He had to resort sparingly to infiltrations in order to enter tournaments, he selects his entries. If he subsequently resorts to the aforementioned surgery, IMHO he is incompatible with a career as a very high level athlete. Especially at 36.