Pinzamiento Posterior Del Tobillo
El pinzamiento posterior del tobillo es una entidad clínica infradiagnosticada, por la cual alguna irregularidad de la articulación de tobillo, alguna exóstosis o pico óseo o algún hueso accesorio pinza la cápsula articular o impide el movimiento normal de la articulación, provocando dolor.
En ocasiones el dolor comienza tras un traumatismo o un movimiento brusco en inestabilidad. En la exploración física, en ocasiones inespecífica, se suele observar dolor a la flexión plantar forzada y en la flexión plantar brusca con la musculatura suelta.
Hay que descartar patología en la musculatura flexora del primer dedo, frecuentemente implicada en el dolor.
Las infiltraciones de glucocorticoides suelen ser efectivas, ecoguiadas en nuestro caso para mayor eficacia, requiriendo en ocasiones agujas específicas – más largas – para aun adecuado acceso a la estructura. En ocasiones, el suero autólogo condicionado también es inyectado con buen resultado. Si hay dudas con respecto al diagnóstico, es posible inyectar anestésico local en la zona con alta precisión para comprobar que desaparece el dolor y el pinzamiento es la causa del mismo.
Si fracasa el tratamiento conservador se debe hacer una cirugía exploratoria para observar el pinzamiento y solucionarlo.
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