Explained: Rafa Nadal's foot RF ablation procedure
Dr. Rajpal Brar, DPT explains the technique
Tennis legend Rafael Nadal is dealing with persistent & ongoing left foot pain due to Muller Weiss syndrome which he’s managed since 2005 - watch my video on Muller Weiss for more information on it.
The pain got to the point that Rafa used nerve blocks to numb his foot during the 2022 French Open - I also have a video on that if you’re interested - but Rafa admitted after his title win that it wasn’t a viable solution or treatment going forward.
RF Ablation
As a potential solution, it’s been reported that Nadal will undergo radiofrequency ablation in which a small hollow needle with an electrode on the end of is inserted into a targeted nerve and heat produced from radio waves (hence radio frequency) will damage the nerve to inhibit pain signals up to the brain and thus provide pain relief.
Appropriate?
RF ablation is considered for chronic, persistent joint pain that hasn’t responded to other treatment, and when a nerve block results in pain relief which indicates that a targeted nerve treatment is effective. Both of these are true in Nadal’s case.
How effective?
In the foot, RF ablations are typically used for neuromas and for heel pain and often requires a series (often three) treatments, depending on response. To that point, following Rafa’s first one, he was seen on crutches in Barcelona and commented that they’ll know more in a few days.
Research in those cases are relatively promising with most having pain relief and over 90% satisfaction. However, data and research on its use for the talonavicular joint affected by Muller Weiss syndrome is sparse and even more so for elite athletes who load the foot and ankle at a much higher rate.
In the short-term, it seems that the RF ablation has taken as Nadal was able to play at Wimbledon and didn’t seem to have any issues with his feet. However, he did suffer a 7mm abdominal tear that was re-aggravated in his gutsy win over Taylor Fritz but after careful consideration, he had to retire from the tournament.
Only time will tell if the ablation procedure will be effective into the medium and long-term for Nadal.
The right move?
It’s pretty clear that Rafa is trying everything within his power to deal with a foot issue that is getting worse and will only continue to deteriorate. There’s no tangible way to solve the root cause of the problem so now it’s how do you best manage the symptoms.
I’m sure many will decry the move but remember - Nadal is someone has managed patellar tendinopathy in both knees since he was 21, has managed his left foot for 17 years, and dealt with an assortment of other overload injuries. He’s been walking a risk/reward tightrope for 15+ years and will continue to do so, he may even tilt more towards risk as he sees the end of the road approaching on his career.
Rafa’s resilience
The same incredible resilience and competitive mentality we see on the court - and many admire him so much for - also applies off of it. He will do everything within his reasonable power to continue playing, it’s that competitive drive that made him the legend he is.
Thank you for reading and thank you for your time. If you need our help with injury recovery, fitness, and/or mindset coaching (we offer virtual & in-person avenues, including online programs) head over to the website.
Dr. Rajpal Brar, DPT, (@3cbperformance) is a physiotherapist, movement expert, strength and conditioning/fitness coach, sports scientist and mindfulness coach. He runs the LA and online based physiotherapy and athletic performance clinic 3CB Performance and you can subscribe to his Youtube channel (which posts a variety of sports injury, performance, and fitness related content).