Fascitis Plantar

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Pacientes tratados
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Intervenciones de cirugía ecoguiada
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Años de experiencia

La fascia plantar es la estructura fibrosa, dura, que contiene el arco del pie y que nos ayuda a caminar. La fascitis plantar es una de las enfermedades más prevalentes en la población general, y se calcula que un 10% de la población va a sufrir una en su vida.

Considerada durante muchos años un proceso inflamatorio de la fascia plantar, se demostró hace décadas mediante estudios histológicos que esta enfermedad no era un proceso inflamatorio, si no degenerativo, al aparecer cambios estructurales en el colágeno, proteína fundamental de la matriz de la fascia plantar, y no células de carácter inflamatorio como los macrófagos. Por esto, el nombre más aceptado en la ciencia hoy en día es FASCIOPATÍA PLANTAR.

El origen de la enfermedad es desconocido, pero parece que un aumento de la actividad física, un calzado inadecuado, una alta velocidad de pronación en la articulación subastragalinas, el acortamiento de la musculatura posterior de la pierna y pasar mucho tiempo de pie son factores de riesgo.

El dolor en el talón suele empezar de forma leve, remitiendo la fasciopatía en muchos pacientes sin realizar ningún tratamiento. Cuando el tiempo va avanzando con persistencia de los síntomas, es momento de buscar ayuda, para realizar un diagnóstico certero. La sintomatología es más intensa en los primeros pasos de la mañana, y tras levantarnos del asiento, pues la posición relajada del pie cuando estamos en reposo no excita los receptores para el dolor, como sí se hace cuando estamos de pie, en movimiento o haciendo deporte. Sí es cierto que a veces cuando el dolor en el talón aparece sólo cuando estamos de pie y no en los primeros pasos, nos indica la posible presencia de una afectación del nervio que da sensibilidad a la zona, como puede ser en la enfermedad del síndrome del túnel del tarso o en el síndrome de Baxter.

plantar
Fascitis plantar-3
Ecografía de la fascia plantar en la que se observa la fascia plantar con su estructura fibrilar conservada y un gran edema en la grasa plantar, siendo diagnósticado de síndrome de la grasa plantar

El origen de la enfermedad es desconocido, pero parece que un aumento de la actividad física, un calzado inadecuado, una alta velocidad de pronación en la articulación subastragalinas, el acortamiento de la musculatura posterior de la pierna y pasar mucho tiempo de pie son factores de riesgo.

El dolor en el talón suele empezar de forma leve, remitiendo la fasciopatía en muchos pacientes sin realizar ningún tratamiento. Cuando el tiempo va avanzando con persistencia de los síntomas, es momento de buscar ayuda, para realizar un diagnóstico certero. La sintomatología es más intensa en los primeros pasos de la mañana, y tras levantarnos del asiento, pues la posición relajada del pie cuando estamos en reposo no excita los receptores para el dolor, como sí se hace cuando estamos de pie, en movimiento o haciendo deporte. Sí es cierto que a veces cuando el dolor en el talón aparece sólo cuando estamos de pie y no en los primeros pasos, nos indica la posible presencia de una afectación del nervio que da sensibilidad a la zona, como puede ser en la enfermedad del síndrome del túnel del tarso o en el síndrome de Baxter.

Las terapias biológicas, como la infiltración con plasma enriquecido en plaquetas, la proloterapia y la electrolisis percutánea intratisular suelen solucionar casi todos los casos, ayudándonos con plantillas ortopédicas personalizadas tras un estudio biomecánico de la pisada si observamos alguna alteración en la forma de andar.

Fascitis plantar-3

Realización de electrolisis percutánea intratisular para fascitis plantar

Fascitis plantar-4

Cirugía ecoguiada para la fascitis plantar, en este caso un caso mixto de fascitis plantar más síndrome del túnel del tarso

En casos más rebeldes, si no hay mejoría con los tratamientos avanzados, optamos generalmente por la cirugía ecoguiada. Con una incisión de uno o dos milímetros, introducimos bajo visión ecográfica directa unos instrumentos diminutos con los que destruimos la región de la fascia fibrosada y la relajamos de forma definitiva si es necesario. Es un procedimiento sencillo, sin puntos, con anestesia local, sin riesgo de sangrado, apto para pacientes diabéticos y con otras enfermedades sistémicas y con apoyo inmediato, que suele requerir baja laboral en gran parte de los pacientes.

Síntomas

Dolor en los primeros pasos de la mañana o tras un tiempo de reposo sentado. También puede aparecer dolor tras mucho tiempo de pie.

Diagnóstico

El diagnóstico se basa en la clínica y en visualizar el estado de la fascia, cuantificar las fibras alteradas y su engrosamiento mediente una ecografía de alta definición de la fascia plantar.

Tratamiento

Las terapias de primer nivel, como las plantillas ortopédicas, y de segundo nivel, como las biológicas – PRP ecoguiado, electrolisis percutánea intratisular, proloterapia – solucionan la práctica totalidad de los casos. En casos persistentes la cirugía ecoguiada ofrece una solución definitiva.

Más sobre la fascitis plantar

Mi interés en esta enfermedad me llevan a seguir investigando constantemente, estando en constante innovación en tratamientos regenerativos y microquirúgicos.

A veces es complicado para un clínico explicar la sensación de estar ante su “enfermedad favorita»: gran parte de mi interés investigador y profesional está en el dolor del talón, en cómo en una región tan pequeña puede tener patología proveniente de la espalda baja, compresiones nerviosas, problemas musculares, de la marcha o toda una combinación de ellos, de forma que hay pacientes auténticamente desesperados y solucionar sus casos complejos es una de las satisfacciones del trabajo diario en consulta y en el área quirúrgica.

Formando a podólogos en ecografía en el año 2016 – Colegio Oficial de Podólogos de Madrid

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Enseñando a los alumnos de 1º de medicina de la Universidad Conplutense de Madrid el trabajo en el laboratorio de anatomía, desarrollando nuevas ténicas de cirugía ecoguiada y tratamiento del dolor de talón

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