Understanding Rafa's Foot Injury

Understanding Rafa's Foot Injury

Rafa's foot injury that has affected his left foot has been an issue for him for some time. It made international headlines at the French Open in 2022, and I think a lot of people have thought that this is a fairly new injury. However, this left foot issue has been there for since 2004, when he first started having medial arch pain and the diagnosis was finally made.

What is the diagnosis?

Muller-Weiss Syndrome is a rare disorder that sees a progressive bone loss of the mid foot. In particular, it is characterized by avascular necrosis (bone death) of the navicular bone. This results in a progressive collapse of the arch and foot shape.  The hallmark feature is a “comma” shape deformation to the navicular. It is a progressive disease that is difficult to manage and as far as the known research suggests – cannot be reversed.

Muller-Weiss is quite different from other syndromes that also result in arch height loss. So if you are reading this and are concerned about your fallen arches, be sure not to panic – but DO seek a professional opinion. Many other arch collapse issues can be rectified with strengthening exercises and orthotics or braces.

Interestingly, Muller-Weiss disease tends to affect more females than males in a 6 to 1 ratio. In the available literature, the age range is between 13, right up to 70. The average age is in the mid 40’s.

Interestingly, Rafa was diagnosed around the age of 20, which is considered quite young for this issue. A theory for the cause of Muller-Weiss is the navicular stress fracture theory, and sure enough, Nadal had a stress fracture in the navicular bone in the years preceding his diagnosis of Muller-Weiss. A stress fracture is a bony break due to repetitive trauma and we know that navicular stress fractures occur in weight bearing athletes (think runners, jumpers, dancers, tennis players etc.). The navicular bone has a poor blood supply and therefore we always treat these very conservatively, with lots of rest. Should the blood supply be disrupted, the bone is at risk of dying. Is that what happened with Nadal’s foot? We don’t’ know for sure, but my suspicion is yes…..

So what can be done?

Arch supports and strengthening exercises can help maintain arch height as best as possible in this case. The forces that act around the foot MUST be managed optimally. This means a strong and healthy muscular system, good movement in the joints and ensuring the entire body is moving smoothly, and easily. I sure hope Rafa is getting a lot of treatment around the foot and ankle to ensure the rest of the joints are moving well and sharing the forces. If you want to see some more arch strength exercises, take a look at our YouTube channel here: https://www.youtube.com/channel/UCoV7dT_JdKnSwS2i5yhItiw – make sure you subscribe as we are always releasing new videos on the latest exercises, tips and tricks to get the most from you feet.

My prediction for Rafa’s future…… I think he has 1-2 seasons left in him until this foot issue either gets just too much worse, requiring a fusion of the bones or the compensation of this injury continues to cause other injuries. Either way I think Rafa’s best is behind him. That being said, I predicted his knee tendon issues would cripple him almost 10 years ago and I got that one wrong for sure.

Whatever happens, we salute you Rafa for your courage and grit, showing what is possible when the mind is focused.

Yours in health,

Andrew Wynd

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