In search of a 14th title at Roland-Garros this Sunday against the Norwegian Casper Ruud, Rafael Nadal will have to deal with his pain in the left foot which has handicapped him for a long time. What is called the Müller-Weiss syndrome could even force the legend to put an end to his career. Focus on a rare disease.
What if Müller-Weiss syndrome was ultimately Rafael Nadal’s most formidable adversary? This disease increasingly handicaps the left foot of the Spanish champion (36 years old), to the point that it could force him to put an end to his legendary career while the Majorcan is seeking a 14th title at Roland-Garros this Sunday, in the final against the Norwegian Casper Ruud.
Müller-Weiss syndrome is a rare pathology affecting a bone in the foot, which can cause chronic pain. The Mallorcan has suffered since he was 18 from osteonecrosis of the navicular bone (or tarsal scaphoid), also known as Müller-Weiss syndrome. A “chronic and incurable” degenerative disease, he said in early May. This syndrome affects the navicular bone, located on the back of the foot, between the talus (formerly called astragalus) and the cuneiform bones.
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“This bone is subject to significant stresses and, for reasons that we do not know, loses its vascularization and necroses”, explains Denis Mainard, president of the French Association of foot surgery and head of the department of orthopedic surgery at the hospital. Nancy hospital.
In the most serious cases and “in subjects who put a lot of strain on their feet, the bone will disintegrate, flatten, it can fragment and, in the end, this can evolve into osteoarthritis with a shortening of the plantar arch. “, he specifies.
Müller-Weiss syndrome can affect only one foot but more often both. Rafael Nadal suffers from only one foot, the left. This pathology more often affects women, and people between 40 and 60 years old.
Osteoarthritis, the last stage of Müller-Weiss syndrome
Professor Mainard does not know the file of the Spanish player. But he raises the “intellectual hypothesis” that he could have been affected, as a child, by Köhler-Mouchet disease, a rare pathology of growth of the navicular bone affecting children under 10, especially athletic boys, and which can leave scars. Müller-Weiss syndrome has five stages: the first is without symptoms, the last is osteoarthritis.
The causes of this disease remain unknown. “In the two authors who initially described it, Müller thought it was more of a traumatic origin, Weiss more of a vascular one. For the moment, we consider that the origin is more of a vascular one”, notes Professor Mainard. Certain factors can increase its risk of occurrence (overweight, flat feet, stress fracture, etc.). This disease is often difficult to diagnose initially, as it develops silently in the early stages. The pain usually appears later.
A possible operation to relieve patients of pain
In addition to rest, orthopedic insoles can reduce mechanical stress. Faced with pain, anti-inflammatory treatments and infiltrations complete the therapeutic panoply. “I live with a ton of anti-inflammatories on a daily basis to give me a chance to be able to train (…) If I don’t take them, I limp”, says Rafael Nadal. And “my problem, for some time now, is that there are many days when I live with too much pain”.
For patients whose pain is no longer relieved and who can no longer walk, surgery may be prescribed. It blocks both joints involving the navicular bone. “In cases where the navicular bone has disintegrated, a bone graft is also needed to restore the length of the internal arch of the foot”, specifies Professor Mainard. “Practicing sport at a high level after such an operation seems difficult”, judges