La aparición de nuevos tratamientos avanzados que regeneran los tendones y fascias, como la electrolisis percutánea ecoguiada, el plasma enriquecido en plaquetas o PRP y el Orthokine, han hecho que cambie nuestra forma de abordar el tratamiento de nuestros pacientes.
Antes era frecuente que la primera opción de tratamiento fuera la infiltración con corticoides, pero estos tienen una serie de inconvenientes:
- En general no son una solución por sí mismos, sólo provocan un alivio sintomático.
- Poseen un gran poder antiinflamatorio, pero suelen estropear y degenerar el tejido.
- En inyección superficial pueden cambiar la pigmentación de la piel.
- Pueden tener efecto sistémico, es decir, efecto farmacológico en la globalidad del cuerpo.
También tienen una serie de ventajas:
- Provocan un rápido alivio de la sintomatología.
- Permiten hacer una rehabilitación indolora.
- Si se combinan con fisioterapia o plantillas ortopédicas personalizadas pueden ser una solución adecuada para muchos problemas.
- Los efectos adversos son raros y poco frecuentes.
En mi opinión la clave es que HAY QUE SELECCIONAR CORRECTAMENTE AL PACIENTE. Es decir, no todo el mundo será susceptible de ser tratado con terapias regenerativas ni todo el mundo deberá ser tratado con corticoides. Hay que tener en cuenta las expectativas del paciente, su actividad, los plazos de recuperación y una serie de variables que nos permitirán, como clínicos, mejorar al paciente de la forma más individualizada posible.
Os expongo el caso de un paciente que acudió a VITRUVIO Instituto de Biomecánica & Salud, mi consulta, con una fasciopatía plantar de media evolución que ya había sido tratada por su fisioterapeuta de confianza con mejoría parcial del cuadro doloroso.
Os pongo la ecografía previa y la posterior.
Este es un claro ejemplo de cómo en sólo 33 días el paciente ha recuperado el grosor normal de la fascia, le ha remitido la sintomatología y tiene una alta satisfacción en el tratamiento.
¿Corticoides nunca, a veces o siempre? DEPENDE
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