Rafael Nadals win at the french open has been all the more interesting considering the chronic foot injury he has been dealing with.
Rafa has been living with Mueller Weiss syndrome - essentially progressive osteonecrosis of the navicular bone that can cause chronic pain in the foot. An injuryy that is quite rare but often finds itself in the podiatrist's rooms.
In a sport like tennis, the loads that end up going through the talonavicular joint as the foot plants and the body keeps moving are massive. The compression of the joint with this type of injury and with these movements would have to be causing a lot of pain.
To alleviate this pain he has said he's been having “painkilling injections” to get through each game and was even considering ablation surgery. Ablation would cause permanent and irreversible cessation of nerve conduction. Wagga Podiatry often does painkilling injections, infact podiatrists are the best placed to perform this treatment due to our knowledge of anatomy.
To me, these comments confirmed that they must be targeting the dorsal sensory nerves (medial, intermediate and dorsal cutaneous nerves) rather than the tibial nerve that runs inferior to the navicular bone. (Personally, this surprised me, I thought more innovation would be coming from the tibial nerve).
Ablation or temporary blocking of the tibial nerve would impair the motor function of the intrinsic muscles of the foot and would have a fairly notable impact on his ability to stabalise the foot and ankle. It seems like blocking the dorsal cutaneous nerves (which have a sensory function only) has had little or no impact on performance??
My conclusion was that it looks like his team has decided that the navicular bone is probably hopeless and that the long term move will be a career finishing surgery. To keep him going, ablation surgery (albeit irreversible) might have little long or short term impact and be a adequate means to prevent pain?? If you are looking for a podiatrist in wagga rafa, give me a call.
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