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How Rafael Nadal has won 20 Slams despite constantly dealing with acute foot pain

Rafael Nadal suffers from a rare foot disease which was diagnosed in 2005
Rafael Nadal suffers from a rare foot disease which was diagnosed in 2005

20-time Major winner Rafael Nadal announced his withdrawal from the US Open last week, citing a foot injury. In the same post Nadal also declared that he would be calling it a season, before expressing hope of returning to competitive tennis in 2022.

Nadal's career, although covered in glory for the most part, has also been plagued by multiple injuries. During the prime of his career, the King of Clay had to fight long bouts of chronic knee ailments which made him miss multiple important tournaments. Nadal has also suffered major injuries to his back, shoulder and left wrist that have deprived him of playing time.

There's a widespread belief that Rafael Nadal's numerous injuries throughout his career are a result of his physical playing style. But that is a very simplistic take on the Spaniard's injuries, and is often voiced by people who have taken no interest in following his career closely.

While Nadal's brutal game style is a contributing factor, it isn't the primary cause of his problems. Nadal is not a self-loathing masochist who would persist with something that was actively harming his body while an alternative existed.

The primary cause instead is something else, something that cannot be fixed: Nadal's left foot.

For a while now, Rafael Nadal had been complaining about pain in his left foot. News of the foot bothering him first emerged after his defeat to Novak Djokovic at Roland Garros back in June. But in his recent statement posted on Twitter, Nadal revealed that the foot has been bothering him for over a year now.

"During this last year I have not had the ability to train and prepare and compete in the way that I really like to," Nadal said.

In fact, as he elucidated further, this isn't a recent issue at all. It is, in fact, the same issue that was first diagnosed back in 2005, when Nadal was just a teenager.

"It is not a new injury, it is an injury that I have had since 2005," Nadal said. "It has prevented me from developing my sports career during all these years."

Fans who weren't aware that Rafael Nadal has had this issue for almost the whole of his professional career were left bewildered by what they were reading. "Why are we only hearing of this now?" and "How did he win 20 Slams while playing on one foot?" were some of the common questions asked by fans on social media.

But those questions are fueled by misinformation. The fact is that we are NOT hearing about this only now; it has always been known to those who have read more into Nadal's chronic knee struggles. But that also does NOT mean that Nadal has played on one foot for the past 15 years; both his feet function quite well.

The "injury" to Rafael Nadal's left foot is not an injury suffered during his playing career at all. It is, in fact, a birth defect that he has always lived with - not just for 15 years, but for as long as he has lived.

The issue is a congenital defect which is considered untreatable. In Nadal's case it has been mitigated with multiple lifehacks throughout his tennis career...just so that he could have a tennis career.

The rare foot problem almost made Rafael Nadal quit tennis in 2005

In 2005, Rafael Nadal was perhaps living the best life a teenager could possibly live. At 19, the force of nature from Mallorca won his maiden Grand Slam at Roland Garros - a citadel the Spaniard would go on to build the majority of his legacy around.

It wasn't just that though. Nadal also hoisted his flag on harcourts in that very year by winning the Canadian and Madrid Masters tournaments. He seemed on the cusp of establishing all-round dominance before he had even turned 20.

But soon after the Madrid win, Rafael Nadal received devastating news from his doctors. He was told that his tennis career was in danger of getting over.

Rafael Nadal could have quit tennis with only one Slam
Rafael Nadal could have quit tennis with only one Slam

Despite being in scintillating form in the weeks leading up to it, Rafael Nadal had to miss the year-ending Tennis Masters Cup in 2005 due to severe pain in his left foot. In his autobiography 'RAFA' (released in 2011), Nadal said that the foot would hurt whenever he stepped on the court despite continued rest, thus eating into a crucial part of his off-season. The Spaniard's doctors failed to provide a diagnosis of the condition for two months.

Finally, a foot specialist in Madrid identified the cause of the pain as a rare condition called 'Kohler's disease'. This is a disorder in which the navicular bone of the foot - the tarsal scaphoid in medical terms - does not harden the way it should during childhood.

As a result, the bone remains underdeveloped and causes painful episodes when put through excessive physical exertion. Nadal explained in his book that his problem was congenital and "very rare".

Getting a clear diagnosis after so long usually comes as welcome news for an athlete. But for Rafael Nadal it was anything but, as his condition was deemed untreatable at his age.

The prognosis for Kohler's disease is usually good when diagnosed and treated in childhood. But Nadal didn't consult a podiatrist until early adulthood, by which time the bone couldn't heal itself any more even with treatment.

The Nadal family's whole world came crashing down when the specialist told them there was a very real possibility he would have to give up on his tennis career.

"It could be, the specialist pronounced, that I'd never be able to play competitive tennis again," Nadal said in his autobiography.

Rafael Nadal often displays the mental strength of a gladiator when he's on the tennis court. But at that moment, being informed of the possibility of his life's dreams being over before he had even turned 20, Nadal was inconsolable.

There came a point when the tennis legend even entertained the prospect of switching to golf as a profession.

Surgery, being an uncertain and unproven treatment for this condition (as the podiatrist said), was ruled out. So Rafael Nadal's doctors came up with a rather strange makeshift solution: a hack.

The soles of the tennis shoes Nadal would wear were altered. They were given a shape that would provide the ailing bone with enough cushioning to ease the pressure put on it while playing tennis.

This unconventional solution worked miracles for Rafael Nadal.

The Spaniard could play top-flight tennis again at the start of 2006. He even managed to get in enough match practice by the middle of the year to go unbeaten during the clay swing and win Roland Garros for a second consecutive year.

Rafael Nadal would go on to win the French Open on a further few occasions; 13 to be precise, out of a total haul of 20 Majors. That's a record in men's tennis which he shares with his greatest rivals Roger Federer and Novak Djokovic.

So you could say he managed to do pretty well in the end, even with a birth defect that threatened to finish his career when he had just a single Slam to his name.

But 'doing pretty well' on the court has come with consequences. Nadal knew of these consequences since the very first day Nike presented him with his newly devised shoes. And he accepted them without thinking twice, because the alternative was giving up on his dreams.

The 'solution' that kept creating problems for Rafael Nadal

If Rafael Nadal's life was a Bollywood movie, the "magical shoe solution" (as Nadal himself calls it) would be the climactic turning point after which everything would be hunky-dory. The ending credits would feature a fast-forwarded montage of Nadal winning his next 19 Slams and the audience would be left in awe, some even shedding a tear or two.

But life isn't like that. It asks for payback every time it throws you a line.

The new shoes allowed Rafael Nadal to forge one of the most celebrated careers an athlete has ever had. But they demanded a price from his knees, his thighs, his back and pretty much every muscle that exists.

The displacement of Nadal's body weight caused by the altered soles transferred the pressure on to the other parts of his body. The navicular bone was provided with cushioning so that it didn't have to handle the weight it normally does, but as a consequence, the other muscles had to bear added weight.

The earliest effects of this were seen on the Spaniard's knees, back in 2009. The peculiar angle of the orthotics in his custom-built shoe, while saving his navicular bone with smart angling, immediately transferred more stress to Rafael Nadal's knees.

That led to Nadal developing patellar tendonitis in both knees at the age of 21. It was a problem that would go on to be a chronic hindrance in his career for many years.

Nadal's withdrawal from Wimbledon 2009, depriving him of the chance to defend the title he won in historic fashion the previous year, was a direct result of that.

Rafael Nadal with both his knees strapped at the 2008 French Open; an effect of the solution to his foot issue
Rafael Nadal with both his knees strapped at the 2008 French Open; an effect of the solution to his foot issue

Rafael Nadal's team managed to find some quick solutions to the new knee complication, which helped him win five Majors over the next three years and even complete the 'Career Slam'. But the issue flared up again in 2012, resulting in Nadal's longest spell away from tennis.

The Spaniard spent seven months on the sidelines, missing the remainder of 2012 after his Wimbledon loss - including the Olympic Games. It was around this time that Nadal's doctors explored a new form of treatment to mitigate his knee issues: stem-cell therapy.

The treatment worked. When Rafael Nadal returned to tennis in the spring of 2013, he defended his French Open crown and went unbeaten during the North American hardcourt season. But the downside was that Nadal lost a considerable amount of his grass-court competitiveness; he couldn't bend his knees as much on the low-bouncing courts anymore.

The knees would continue bothering him every once in a while over the next few years, even though the major issue seemed to have been lightened. But in 2014, Rafael Nadal would have to receive stem-cell injections once more - this time for his back.

Although Nadal has never expressly connected the back injury to his foot defect, many believe it was a result of the foot 'solution'. The back problem famously prevented the Spaniard from giving his best in the Australian Open final against Stan Wawrinka.

In 2018, during the off-season, Nadal went under the knife for an operative procedure on his right ankle. He came back looking healthy at the start of 2019, but he continued having minor niggles on various parts of his body after that.

Withdrawing from tournaments and taking short spells off tennis to rest an aching muscle has been a constant fixture of Rafael Nadal's career. He has had to withdraw from 11 Majors since 2004, most of which were directly or indirectly related to this birth defect in his foot.

Nadal has been very vocal about his daily tryst with pain. For that he is often revered by the well-informed, but at the same time he is also criticized by cynics who can't comprehend the fact that a perpetually injured player could win 20 Slams.

The Spaniard has famously said he can't remember ever playing without pain, and has also frequently opened up about painkillers being his constant companion on tour. It almost makes you wonder whether any tennis player has been dealt such a harsh hand by fate.

And yet the source of all the problems, the Kohler's disease in Rafael Nadal's left foot, still bothers him without respite. Nadal mentioned in his book that the navicular bone always hurts, requiring constant massaging to keep the pain under control.

The shoe solution itself wasn't absolute or unmodified. Nadal's team has had to keep making minor changes to the soles over the past 15 years as and when a need has arisen. But even that hasn't been enough to make him pain-free.

What's next for Rafael Nadal?

From the looks of things, the temporary fixes have stopped working. Maybe the customized soles aren't shielding the deficient bone from being put under pressure anymore. It is possible that although the shoes prevented the bone from immediate strain, the accumulated stress from 17 years of professional tennis has taken things beyond the point of repair.

Rafael Nadal's coach Carlos Moya said in a recent interview that the team doesn't yet know what the right course of treatment is. But in his Instagram video, Nadal sounded hopeful of finding a solution to the problem and even visualized, in his own words, "a couple of more beautiful seasons".

Maybe the Spaniard and his doctors will once again succeed in finding a solution to his physical issues, as they always have. But there is a distinct possibility that they won't. Maybe Nadal will make another one of his astonishing comebacks to tennis, or maybe this time he can't.

There is also a growing chorus that Rafael Nadal may be done winning Slams. But even if that's the case, even if the sun has in fact set on one of the greatest champions our sport has ever seen, Nadal's career will always be remembered and referenced whenever adversity strikes. And that's not only in tennis or sport, but also in life.

Rafael Nadal's career has been a fairytale, as he often describes it. But it's been a painful fairytale.

It is said that time heals everything, or at least makes you forget. But perhaps that's not always the case. Perhaps sometimes, time doesn't heal everything; instead, it just teaches you to live with the pain.

And Rafael Nadal, as the last 17 years have shown us, is the finest example of living with, and conquering, pain.

What is the foot injury that has troubled Rafael Nadal over the years? Check here

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Edited by Musab Abid
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