Hace pocos días vino a consulta un paciente con una “fascitis plantar”. Esa conclusión había sacado él mirando por internet y el profesional de la salud al que había acudido fue lo que le diagnosticó. En este caso su médico de familia, quien le prescribió antiinflamatorios no esteroideos sin mejoría.
Varias cosas me hicieron sospechar que no era una fascitis o fasciopatía plantar al uso:
- Mecanismo de acción: jugando un partido de fútbol sintió un dolor brusco y lacerante.
- No presentaba el dolor típico. Tenía sensaciones álgicas por la mañana pero también durante todo el día. Sí que le calmaba el reposo.
- Persistía un leve hematoma apenas visible tras 7 semanas de evolución del cuadro.
Le realicé un estudio biomecánico en el que se apreciaba un apoyo inicial en ligero varo / supinador que durante el apoyo final comienza el momento levemente pronador mayor en MII. Inestabilidad en giros rápidos. Además presentaba gastrocnemios cortos con test de Silverskiöld + y hallux limitus bilateral.
Tengo la suerte de que en mi consulta también tengo ecógrafo, y fue lo que permitió sacar la conclusión diagnóstica adecuada. Le realicé una ecografía que informé así:
“Se aprecia imagen hipoecoica en entesis de aponeurosis plantar izquierda que afecta parcialmente al espesor de la fascia de 0,35 x 0,39 cts. En el corte transverso persiste la imagen, siendo esta compatible con rotura parcial de la aponeurosis plantar. Al forzar el mecanismo de windlass se aprecia dehiscencia de los bordes. También se aprecia engrosamiento de la fascia izquierda en comparación con la contralateral”.
Era una rotura de la fascia plantar. ¿Qué le prescribí?
- Plantillas ortopédicas para amortiguar el impacto y controlar la tensión en la fascia
- Vendaje hasta entrega del tratamiento ortopédico.
- Infiltración con Orthokine o suero autólogo condicionado (un tipo de PRP).
- Reposo deportivo hasta dolor medido por EVA de 2-3 sobre 10.
Este caso me hizo reflexionar sobre la importancia de las pruebas diagnósticas en podología, en ocasiones minusvaloradas a favor la clínica. Creo que son importantes en ocasiones en las que:
- La sintomatología de una patología no cuadra con la exploración.
- Evolución tórpida de un tratamiento.
Y si lo tenemos a mano en consulta, para todo, pues mejora de manera sustancial nuestros diagnósticos y pronósticos.
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