Rafael Nadal's toughest opponent: Muller-Weiss syndrome

• Sports

Rafael Nadal will play tomorrow in the semi-finals of the Roland Garros 2022: a very tough match, against Alexander Zverev, mainly due to the foot problem that the 21-times-Slam-champion is suffering: the Muller-Weiss syndrome.

It is a disease of unknown causes, which does not cause symptoms except when very little can be done. Doctor Umberto Alfieri Montrasio, head of the foot and ankle specialist unit of the IRCSS Galeazzi Orthopedic Institute in Milan, explained to Gazzetta Active what this disease entails: "This disease is characterized by the fragmentation and necrosis of the navicular or tarsal scaphoid which over the years leads to an arthritic process of those joints that rotate around the scaphoid itself.

It is such a rare disease that even the literature is very scarce. Sometimes it is even mistaken for a fracture. Müller-Weiss syndrome is a degenerative disease so rare that even in the scientific literature many publications are case reports or case histories of a few patients.

What little is known is that, generally, woman are more affected, with an incidence of 70%, again according to the few studies conducted to date. The average age of onset of Müller-Weiss syndrome is around 45 years, and more generally between 40 and 60 years.

For this reason the case of Nadal is even more particular, given he is a man and his young age. A primary osteonecrosis has been hypothesized, the origin of which is unknown, 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 microtrauma. 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 slowing down of the maturation process of the Scaphoid. This pathology is subtle because it does not give symptoms: 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.

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."