TENDINOPATIA ACHILLEA E FASCITE PLANTARE: i buoni risultati dell'eco-interventistica muscoloscheletrica in due patologie "rognose":
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TENDINOPATIA ACHILLEA E FASCITE PLANTARE: i buoni risultati dell'eco-interventistica muscoloscheletrica in due patologie "rognose":

Considerazioni su nostre recenti esperienze nel trattamento di complessi casi di FASCITE PLANTARE  e di TENDIPATIA ACHILLEA
 
Per fascite plantare si fa riferimento ad un processo infiammatorio del cosiddetto “legamento arcuato” altrimenti denominato “aponeurosi plantare”, che è una fascia fibrosa che decorre in avanti dalla zona mediale del calcagno fino a fondersi con i legamenti che s’inseriscono sulle dita.
Di solito il processo infiammatorio avviene a livello della inserzione calcaneare (meno vascolarizzata), può essere o meno associato  alla spina calcaneare e cioè ad una formazione ossea speroniforme che si forma a livello del processo mediale del calcagno.
La fascite plantare avviene prevalentemente per modificazioni degenerative dovute ad una eccessiva sollecitazione con conseguenti  microtraumi ripetuti a livello dell’inserzione della fascia plantare che causano una periostite da trazione e microlacerazioni.

La tendinopatia achillea è un’affezione del tendine di Achille.
Coinvolge solitamente chi pratica sport, dopo i 18 anni, che sovraccaricano tale tendine come la corsa, il salto, calcio ecc..
Le cause più frequenti sono: microtraumatismi ripetuti (calzature inidonee, errori di allenamento, campi di gara incongrui), ipersollecitazioni funzionali, alterazioni anatomiche e funzionali del piede, malattie metaboliche e reumatologiche, predisposizione genetica.
Frequente nel calcagno è la sindrome di Haglund, patologia della regione calcaneare posteriore caratterizzata da borsite retroachillea, tendinopatia inserzionale del tendine di Achille e prominenza dell’angolo calcaneare superiore che determina impingement con la faccia anteriore del tendine d’Achille.

Abbiamo applicato un protocollo terapeutico abbastanza standardizzato, naturalmente fondato su tecniche infiltrative moderne, ecoassistite

Per la FASCITE PLANTARE:

  1. previa accurata sterilità ed anestesia locale, 
  2. introduzione sotto assistenza ecografica di ago 20 G
  3. needling e bleeding di eventuale spina calcaneare
  4. iniezione intratendinea di acido ialuronico a medio peso molecolare
  5. infiltrazione con steroide perifasciale ed extra cuscinetto adiposo calcaneare (separando bene i due piani con S.F. onde evitare fenomeni di liponecrosi steroidea o danni alla fascia).  

Per la TENDINOPATIA ACHILLEA:

  1. dopo accurata sterilità ed anestesia locale
  2. introduzione sotto guida ecografica di ago 18-20 G
  3. bleeding di eventuale spina achillea
  4. iniezione intratendinea e peritendinea di acido ialuronico a medio peso molecolare
  5. infiltrazione con steroide rigorosamente in sede peritendinea, extratendinea.
  6. trattamento di eventuale borsite retro e/ pre-calcaneare con lavaggio-sbrigliamento della borsa ed infiltrazione con  corticosteroide intrabursale.

In entrambe le situazioni, dopo il trattamento, forniamo al Paziente un addestramento specifico per esercizi di stretching e di FKT della fascia plantare e del tendine achilleo. Raccomandiamo inoltre uno studio professionale dell'appoggio e della adeguata calzatura con eventuale opportuno plantare.

Recentemente abbiamo trattato Pazienti estremamente etrogeni per caratteristiche fisiche (alcuni in marcato sovrappeso, altri sportivi ed in buona forma), età (giovani di 25-35 anni e "ragazzi" ultra-ottantenni, ancora buone condizioni e capaci di discreta attività motoria), sesso ed attività (cuochi e camerieri, calciatori, ultramaratoneti, pensionati), tutti accomunati dalla intensa sintomatologia dolorosa, dalla ridotta capacità funzionale e dallo scarso risultato terapeutico di altre terapie.

I risultati sono decisamente incoraggianti.
Su circa 30  Pazienti trattati
  • uno, atleta podista di lunghe distanze, ultramaratoneta, ha riferito al controllo dopo 1 mese, un non completo risultato in quanto la sintomatologia dolorosa, in sede plantare, si riaffacciava quando superava il  55-60° KM di corsa(!).
  • Un'altro Paziente, di circa 60 anni, di professione cameriere, con una notevole sindrome di Haglund, pur essendo stato trattato due volte, non sembra aver  significativamente  beneficiato della terapia.
  • Tutti gli altri Pazienti hanno tratto o completo o notevole o significativo giovamento, da una singola seduta di trattamento.
  • Tutti i Pazienti sono stati controllati clinicamente ed ecograficamente a distanza dopo il trattamento: nessun Paziente ha avuto effetti indesiderati o complicanze degne di significato.

 
 
 

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TENDINOPATIA ACHILLEA E FASCITE PLANTARE: i buoni risultati dell'eco-interventistica muscolosche on venerdì 23 novembre 2018 04:48
Licensed Financial Planner Board of Standards Inc.
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Licensed Financial Planner Board of Standards Inc.
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TENDINOPATIA ACHILLEA E FASCITE PLANTARE: i buoni risultati dell'eco-interventistica muscolosche on venerdì 23 novembre 2018 06:13
Investments in most securities contain risks.
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TENDINOPATIA ACHILLEA E FASCITE PLANTARE: i buoni risultati dell'eco-interventistica muscolosche on venerdì 23 novembre 2018 06:23
Certified Financial Planner Board of Requirements Inc.
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Investments in most securities contain risks.
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Certified Financial Planner Board of Requirements Inc.
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TENDINOPATIA ACHILLEA E FASCITE PLANTARE: i buoni risultati dell'eco-interventistica muscolosche on venerdì 23 novembre 2018 19:29
Investments in most securities contain dangers.
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TENDINOPATIA ACHILLEA E FASCITE PLANTARE: i buoni risultati dell'eco-interventistica muscolosche on sabato 24 novembre 2018 10:52
Licensed Financial Planner Board of Standards Inc.
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TENDINOPATIA ACHILLEA E FASCITE PLANTARE: i buoni risultati dell'eco-interventistica muscolosche on sabato 24 novembre 2018 18:34
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TENDINOPATIA ACHILLEA E FASCITE PLANTARE: i buoni risultati dell'eco-interventistica muscolosche on sabato 24 novembre 2018 23:53
Licensed Financial Planner Board of Requirements Inc.
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