What is the Mueller-Weiss Syndrome, Nadal’s major handicap?

Rafael Nadal has been playing through pain for many years now. While his all-action style has brought him much success, it has left his body weaker for it. After years of battling injury, the Spaniard was diagnosed with Mueller-Weiss Syndrome in his left foot about a year ago. A rare congenital condition affecting the bones in one’s feet, the syndrome is marked by the degeneration of the adult tarsal navicular, a crucial bone in the midfoot. It results in extreme pain and even deformity of the foot.

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Speaking to AS, Gilbert Versier, former chief of the orthopaedic department in Vincennes military hospital, gives a lowdown on how the syndrome affects the feet:

“It usually affect people who have flat feet. It’s congenital. In some people, the arch of the foot is more pronounced – in other words, there is a greater distance between the sole of the foot and the floor. Others have a fallen arch when the insole loses its curvature and those people tend to be more susceptible to this kind of pathology. It causes the navicular bone to become compressed which eventually develops necrosis. Basically the bone dies, it loses its vascularization.”

Adding further, he cites how stress fractures can be a potential cause:

“A stress fracture could also be the cause – when bones don’t heal properly. When the fracture occurs at the point where vascularization no longer reaches it, the area where the blood vessels are which could result in a necrosis. But it is a very rare pathology, and its origins are not very clear. It’s not a pathology which necessarily evolves very quickly. Deterioration happens over time and is quite painful, but usually osteoartritis takes a long time to develop. We have seen these kinds of conditions in women over the age of 50. It is not something we tend to see in young people.”

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While Nadal’s case is made curious by the fact that the Mueller-Weiss syndrome (also known as Brailsford disease) usually affects people in the 40-60 age group, his intense style of play is perhaps the reason for its early onset. The Spaniard has suffered from a litany of injuries in his career- with hip, back, wrist, hamstring and hip problems- but this seems particularly debilitating. With no accepted operative treatment in place, recovering from this syndrome is tricky, if not impossible. While surgery is an option, Dr Versier advises against it. “Such a procedure jams up the foot leaving the patient able to walk but not run. That’s why we delay such operations and perform them only on patients who are in a lot of pain and unable to walk properly,” he would explain to AS.

In fact, such is the severity of the condition there have been indications from the Rafa camp that this might be his last French Open. It is a sign of his greatness that he has managed to prolong his career in spite of all the rigours his body has had to suffer through. With an emotional final on the horizon, expect the southpaw to go wring every last bit of effort from his fraying feet to secure a record-extending 14th Mousquetaires.