{"id":13070,"date":"2020-05-21T19:35:33","date_gmt":"2020-05-21T17:35:33","guid":{"rendered":"http:\/\/old.institutcataladelpeu.com\/?p=13070"},"modified":"2020-05-22T18:46:17","modified_gmt":"2020-05-22T16:46:17","slug":"heloma-per-inclusio-concepte-clinica-i-tractament","status":"publish","type":"post","link":"https:\/\/old.institutcataladelpeu.com\/ca\/heloma-per-inclusio-concepte-clinica-i-tractament\/","title":{"rendered":"Heloma per inclusi\u00f3. Concepte, cl\u00ednica i tractament"},"content":{"rendered":"\n
<\/p>\n\n\n
L\u2019heloma plantar, conegut vulgarment com a \u201cclau\u201d, \u00e9s una hiperqueratosi focalitzada que afecta la capa m\u00e9s profunda de l’epidermis a conseq\u00fc\u00e8ncia de la pressi\u00f3 exercida a la pell per un punt ossi o un agent extern en la mateixa direcci\u00f3 i de sentit oposat.<\/span><\/span><\/span><\/p>\n
A vegades, l’alteraci\u00f3 de l’estrat basal i de les crestes epid\u00e8rmiques fa recidivar l\u2019heloma en el temps encara que s’elimini la pressi\u00f3 exercida sobre l’epidermis.<\/span><\/span><\/span><\/p>\n
L\u2019heloma es produeix per hiperpressi\u00f3 de la pell entre dos plans o superf\u00edcies dures. B\u00e9 sigui per pressi\u00f3 entre un os del peu contra un agent extern com per exemple el cal\u00e7at o el s\u00f2l o b\u00e9 sigui la pressi\u00f3 exercida a la pell per dues superf\u00edcies \u00f2ssies (per exemple l\u2019heloma interdigital que apareix entremig de dos dits). Aquesta pressi\u00f3 produeix una isqu\u00e8mia o falta de reg sanguini en l’epidermis produ\u00eft per l’aparici\u00f3 de queratina des de la capa basal fins a la c\u00f2rnia per un proc\u00e9s de queratinitzaci\u00f3 dels queratin\u00f2cits. Aix\u00f2 dona lloc al fet que la localitzaci\u00f3 dels helomes sigui molt diversa. Poden apar\u00e8ixer a la planta del peu, entremig dels dits, en el dors dels dits o en el contorn de la l\u00e0mina unguial.<\/span><\/span><\/span><\/p>\n
Cl\u00ednicament, els helomes apareixen recoberts d’una callositat amb una textura dura i dolorosa a la pressi\u00f3 directa sobre l\u2019heloma a difer\u00e8ncia de les dur\u00edcies simples o calls que s\u00f3n m\u00e9s superficials i indolors. Presenten una coloraci\u00f3 beix fosca i una superf\u00edcie circularment delimitada. Al deslaminar la hiperqueratosi observem una estructura querat\u00ednica de forma c\u00f2nica sent la base del con la zona m\u00e9s superficial de la pell i l’\u00e0pex del con la zona m\u00e9s profunda de l’epidermis. Aix\u00f2 es deu al fet que la pressi\u00f3 \u00e9s conc\u00e8ntrica i es produeix des de la superf\u00edcie cut\u00e0nia cap a l’interior de l’epidermis. Per aquest motiu els helomes no tenen arrel, ja que en ser lesions per pressi\u00f3 o fricci\u00f3 es reprodueixen sempre que es repeteix la mateixa circumst\u00e0ncia.<\/span><\/span><\/span><\/p>\n
La prevenci\u00f3 de l’aparici\u00f3 dels helomes ha de valorar b\u00e0sicament:<\/span><\/span><\/span><\/p>\n
1- El cal\u00e7at. Les soles fines o poc flexibles afavoreixen l’aparici\u00f3 dels helomes. Els cal\u00e7ats anat\u00f2mics, amples i sense excessives costures aix\u00ed com talons fisiol\u00f2gics redueixen l’aparici\u00f3 de l\u2019heloma.<\/span><\/span><\/span><\/p>\n
2- L’an\u00e0lisi de la trepitjada. Encaminat a detectar possibles anomalies de la deambulaci\u00f3 que puguin provocar pressions inadequades.<\/span><\/span><\/span><\/p>\n
3- La morfologia del peu i les seves alteracions (galindons, dits en arpa, insufici\u00e8ncies metatarsals, etc). \u00c9s important l’an\u00e0lisi podol\u00f2gica de les possibles deformitats del peu que poden ocasionar fricci\u00f3 i pressi\u00f3 amb els cal\u00e7ats. Aquesta valoraci\u00f3 ens ajudar\u00e0 a l’elecci\u00f3 del tractament m\u00e9s correcte (ortesi de silicona, plantilles o cirurgia).<\/span><\/span><\/span><\/p>\n
El tractament de l\u2019heloma \u00e9s divers. La quirop\u00f2dia \u00e9s el tractament m\u00e9s immediat i amb excel\u00b7lents resultats simptom\u00e0tics a curt termini. Es tracta de la deslaminaci\u00f3 de la capa c\u00f2rnia amb bistur\u00ed mitjan\u00e7ant l\u2019enucleaci\u00f3 total de la capa querat\u00ednica. Segons les causes que provoquen l\u2019heloma, la reaparici\u00f3 en el temps ser\u00e0 m\u00e9s o menys freq\u00fcent.<\/span><\/span><\/span><\/p>\n
En els casos que l\u2019heloma reapareix amb freq\u00fc\u00e8ncia o intensitat, tenim l’opci\u00f3 de tractaments conservadors per a reduir les pressions que provoquen aquesta lesi\u00f3. Aquests tractaments poden consistir en plantilles personalitzades en el cas d\u2019helomes plantars, o b\u00e9 ortesis digitals de silicona en el cas d\u2019helomes a nivell digital.<\/span><\/span><\/span><\/p>\n
Quan els tractaments conservadors fracassen, pot plantejar-se com a tractament resolutiu la cirurgia. En el cas d\u2019helomes interdigitals s’elimina l\u2019ex\u00f2stosi o promin\u00e8ncia \u00f2ssia causant i en els helomes dorsals, la cirurgia va orientada a la correcci\u00f3 d’una alineaci\u00f3 incorrecta del dit (arpa, martell, etc.) com a causa de la fricci\u00f3 d’aquest amb el cal\u00e7at.<\/span><\/span><\/span><\/p>\n
\u00c9s possible la intervenci\u00f3 quir\u00fargica d\u2019helomes plantars, per\u00f2 s\u2019ha de valorar en profunditat la seva necessitat ja que pot induir a efectes secundaris no desitjats.<\/span><\/span><\/span><\/p>\n
<\/p>\n
Helomes plantars per inclusi\u00f3. Observeu la relaci\u00f3 dels helomes amb les zones de c\u00e0rrega.<\/p>\nHeloma plantar al cap del segon metatarsi\u00e0.<\/p>\n
<\/figure>\nHeloma dorsal acompanyat d’hematoma per microtraumatisme (molt freq\u00fcent).<\/figcaption><\/figure>\nHelomes plantars per inclusions m\u00faltiples.<\/p>\n<\/figure>\nHeloma plantar per aplanament estructural del peu<\/p>\n<\/figure>\nHeloma plantar infectat i hematoma subcutani<\/p>\n<\/figure>\nHeloma plantar en primer dit.<\/figcaption><\/figure>\n<\/p>\n
Heloma plantar per inclusi\u00f3 al capdavant del tercer metatarsi\u00e0.<\/span><\/span><\/span><\/figure>\n
Heloma per inclusi\u00f3. Concepte, cl\u00ednica i tractament - Institut Catal\u00e0 del Peu<\/title>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"ca_ES\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Heloma per inclusi\u00f3. 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![\"Heloma](\"http:\/\/old.institutcataladelpeu.com\/wp-content\/uploads\/2020\/05\/institut-catala-del-peu-ojo-de-pollo-foto-1-1-822x1030.jpg\" "\\"Heloma")
<\/p>\n![\"Heloma](\"http:\/\/old.institutcataladelpeu.com\/wp-content\/uploads\/2020\/05\/institut-catala-del-peu-ojo-de-pollo-foto-2-1-1030x731.jpg\" "\\"Heloma")
Heloma plantar al cap del segon metatarsi\u00e0.<\/p>\n![\"Heloma](\"http:\/\/old.institutcataladelpeu.com\/wp-content\/uploads\/2020\/05\/institut-catala-del-peu-ojo-de-pollo-foto-3-1-1030x727.jpg\" "\\"Heloma")
<\/figure>\n![\"Heloma](\"http:\/\/old.institutcataladelpeu.com\/wp-content\/uploads\/2020\/05\/institut-catala-del-peu-ojo-de-pollo-foto-4-1-1030x732.jpg\" "\\"Heloma")
Helomes plantars per inclusions m\u00faltiples.<\/p>\n<\/figure>\n![\"Heloma](\"http:\/\/old.institutcataladelpeu.com\/wp-content\/uploads\/2020\/05\/institut-catala-del-peu-ojo-de-pollo-foto-5-1-795x1030.jpg\" "\\"Heloma")
Heloma plantar per aplanament estructural del peu<\/p>\n<\/figure>\n![\"Heloma](\"http:\/\/old.institutcataladelpeu.com\/wp-content\/uploads\/2020\/05\/institut-catala-del-peu-ojo-de-pollo-foto-6-1-1030x737.jpg\" "\\"Heloma")
Heloma plantar infectat i hematoma subcutani<\/p>\n<\/figure>\n![\"Heloma](\"http:\/\/old.institutcataladelpeu.com\/wp-content\/uploads\/2020\/05\/institut-catala-del-peu-ojo-de-pollo-foto-7-1-792x1030.jpg\" "\\"Heloma")
Heloma plantar en primer dit![\"Heloma](\"http:\/\/old.institutcataladelpeu.com\/wp-content\/uploads\/2020\/05\/institut-catala-del-peu-ojo-de-pollo-foto-8-1-797x1030.jpg\" "\\"Heloma")
<\/p>\n