{"id":2989,"date":"2015-09-17T09:42:49","date_gmt":"2015-09-17T09:42:49","guid":{"rendered":"http:\/\/old.institutcataladelpeu.com\/ca\/?p=2989"},"modified":"2016-10-18T10:45:19","modified_gmt":"2016-10-18T10:45:19","slug":"el-mal-perforant-plantar-complicacio-greu-del-peu-diabetic","status":"publish","type":"post","link":"https:\/\/old.institutcataladelpeu.com\/ca\/el-mal-perforant-plantar-complicacio-greu-del-peu-diabetic\/","title":{"rendered":"El mal perforant plantar. Complicaci\u00f3 greu del peu diab\u00e8tic"},"content":{"rendered":"
\n

El mal perforant plantar, tamb\u00e9 descrit com a \u00falcera neurop\u00e0tica, \u00e9s la complicaci\u00f3 m\u00e9s greu de la neuropatia diab\u00e8tica.Aquesta lesi\u00f3 ulcerosa en el peu diab\u00e8tic pot tenir el seu origen en la neuropatia motora, sensorial o aut\u00f2noma:<\/p>\n

1) La neuropatia motora<\/span> provoca atr\u00f2fia de la musculatura intr\u00ednseca del peu i per tant deformitats \u00f2ssies i rigidesa articular, com per exemple dits en urpa o promin\u00e8ncies dels caps metatarsals a nivell plantar. Qualsevol deformitat \u00f2ssia que no s’adapti correctament al cal\u00e7at, comportar\u00e0 un risc important\u00edssim d’aparici\u00f3 d’una \u00falcera neurop\u00e0tica.<\/p>\n

2) La neuropatia sensorial<\/span> \u00e9s un factor clau en la formaci\u00f3 del mal perforant plantar. En un pacient diab\u00e8tic, la falta de sensibilitat unida a una deformitat anat\u00f2mica del peu, es convertir\u00e0 a curt termini en una \u00falcera neurop\u00e0tica per hiperpressi\u00f3.<\/p>\n

3) La neuropatia aut\u00f2noma<\/span> provoca sequedat cut\u00e0nia i aparici\u00f3 d’esquerdes. Aquestes petites alteracions d\u00e8rmiques poden evolucionar negativament i ser l’avantsala d’una \u00falcera neurop\u00e0tica. La pres\u00e8ncia d’esquerdes en la pell del pacient diab\u00e8tic \u00e9s un risc d’infecci\u00f3, i m\u00e9s si va acompanyat d’un trastorn vascular.<\/p>\n

El mal perforant plantar apareix com una lesi\u00f3 d\u00e8rmica de morfologia arrodonida i acompanyat d’hiperqueratosi o callositat important. \u00c9s indolor, per la qual cosa alguns pacients diab\u00e8tics no li presten l’atenci\u00f3 pertinent fins a estadis m\u00e9s avan\u00e7ats. \u00c9s una \u00falcera bastant neta i que apareix en zones del peu sotmeses a major pressi\u00f3.<\/p>\n

No sempre ens trobarem una \u00falcera neurop\u00e0tica en estat pur sin\u00f3 que en molts casos tindr\u00e0 un component major o menor d’isqu\u00e8mia. En el cas de no presentar-se alteracions vasculars, el peu afecte per una \u00falcera neurop\u00e0tica presentar\u00e0 polsos palpables i un aspecte cutani rosat amb bona temperatura.<\/p>\n

\u00c9s important en iniciar un tractament d’una \u00falcera neurop\u00e0tica, la realitzaci\u00f3 d’una radiografia per valorar l’exist\u00e8ncia d’oste\u00eftis, un cultiu per con\u00e8ixer el tipus d’agent causant aix\u00ed com l’aplicaci\u00f3 d’antibi\u00f2tics d’ampli espectre fins a con\u00e8ixer el resultat del cultiu. Si en les posteriors setmanes l’\u00falcera neurop\u00e0tica no evoluciona favorablement, \u00e9s aconsellable la realitzaci\u00f3 d’una gammagrafia \u00f2ssia amb leuc\u00f2cits marcats amb la finalitat de descartar una possible oste\u00eftis no detectada pr\u00e8viament.<\/p>\n

El tractament \u00e9s complex i ha de ser multidisciplinari. L’actuaci\u00f3 del professional enfront d’aquest tipus d’alteraci\u00f3 ser\u00e0:<\/p>\n

a) La neteja de la zona ulcerosa mitjan\u00e7ant s\u00e8rum fisiol\u00f2gic per disminuir el risc d’infecci\u00f3 i facilitar la cicatritzaci\u00f3. Cal evitar traumatitzar la zona i destruir el teixit en fase de granulaci\u00f3, ha de realitzar-se prou neteja com per arrossegar els detritus i el teixit necr\u00f2tic.<\/p>\n

b) El desbridament de detritus, esfacels o necrosi ajudar\u00e0 a evitar la infecci\u00f3 i facilitar\u00e0 el proc\u00e9s de cicatritzaci\u00f3. Hi ha diverses t\u00e8cniques de desbridament: el mec\u00e0nic (mitjan\u00e7ant arrencament), l’enzim\u00e0tic (mitjan\u00e7ant f\u00e0rmacs t\u00f2pics), l’autol\u00edtic (mitjan\u00e7ant hidrogels) i el tallant o quir\u00fargic (mitjan\u00e7ant bistur\u00ed). Segons l’estat general del pacient i la classe de teixit present es dur\u00e0 a terme una t\u00e8cnica o una altra.<\/p>\n

c) La cura de l’\u00falcera es realitzar\u00e0 mitjan\u00e7ant f\u00e0rmacs, depenent de l’estat de la ferida. S’hauran de realitzar cures setmanals en la consulta per observar l’evoluci\u00f3 de la lesi\u00f3. Cal descarregar la zona de la pressi\u00f3 a la qual es veu sotmesa mitjan\u00e7ant rep\u00f2s relatiu, feltres d’1 cm de gruix, plantilles o suports plantars, ortesis de silicona, guixos, sabata postquir\u00fargica o cal\u00e7at terap\u00e8utic. La reducci\u00f3 de la pressi\u00f3 no nom\u00e9s dep\u00e8n del tractament aplicat sin\u00f3 del compliment de les pautes per part del pacient i de la biomec\u00e0nica.<\/p>\n

d) La cicatritzaci\u00f3 \u00e9s l’epitelitzaci\u00f3 dels teixits, la qual haurem de controlar durant les cures. Una cura humida afavorir\u00e0 l’epitelitzaci\u00f3 dels teixits.<\/p>\n

La impossibilitat d’una bona cicatritzaci\u00f3 de l’\u00falcera neurop\u00e0tica estar\u00e0 associada a una malaltia vascular perif\u00e8rica (pel seu component isqu\u00e8mic), a una mala praxi en la desc\u00e0rrega de l’\u00falcera o b\u00e9 per la pres\u00e8ncia d’osteomielitis<\/p>\n

Un frac\u00e0s del tractament conservador enfront de la cicatritzaci\u00f3 de l’\u00falcera neurop\u00e0tica comportar\u00e0 un tractament quir\u00fargic orientat a realitzar les osteotomies mec\u00e0niques a fi d’alliberar la lesi\u00f3 ulcerosa de la pressi\u00f3 exercida per l’os, cosa que d\u00f3na un resultat efica\u00e7 a curt termini. En els casos en qu\u00e8 existeixi osteomielitis, la cirurgia s’orientar\u00e0 a la resecci\u00f3 de la zona afecta.<\/p>\n

\"ElMal perforant plantar.<\/a><\/p>\n

\"ElMal perforant plantar en el 1er dit. Osteitis.<\/a><\/p>\n

\"ElMal perforant plantar en zona metatarsal.<\/a><\/p>\n

\"ElPie politraum\u00e0tic amb afecci\u00f3 del quart radi per mal perforant plantar.<\/a><\/p>\n

\"ElAfectaci\u00f3 del primer radi per mal perforant plantar.<\/a><\/p>\n

\"ElCas cl\u00ednic de mal perforant plantar e infecci\u00f3 en primer cap metatarsal.<\/a><\/p>\n

\"ElEvoluci\u00f3 del cas a las 3 semanes.<\/a><\/p>\n

\"ElEvoluci\u00f3 del cas als 2 mesos.<\/a><\/p>\n

\"ElEvoluci\u00f3 del cas als 3 mesos.<\/a><\/p>\n

\"ElCas cl\u00ednic del mal perforant plantar amb doble lesi\u00f3 ulcerosa de component neurop\u00e0tic.<\/a><\/p>\n

\"ElEvoluci\u00f3 del cas a les 4 semanes.<\/a><\/p>\n

\"ElEvoluci\u00f3 del cas als 3 mesos.<\/a><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

El mal perforant plantar, tamb\u00e9 descrit com a \u00falcera neurop\u00e0tica, \u00e9s la complicaci\u00f3 m\u00e9s greu de la neuropatia diab\u00e8tica.Aquesta lesi\u00f3 ulcerosa en el peu diab\u00e8tic pot tenir el seu origen en la neuropatia motora, sensorial o aut\u00f2noma: 1) La neuropatia motora provoca atr\u00f2fia de la musculatura intr\u00ednseca del peu i per tant deformitats \u00f2ssies i […]<\/p>\n","protected":false},"author":3,"featured_media":5595,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[276,279,282,346,306,307],"tags":[347],"class_list":["post-2989","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-alteracions-dermatologiques","category-altres","category-articles","category-icp-ca","category-patologia-ca","category-peu-diabetic","tag-peu-diabetic"],"yoast_head":"\nEl mal perforant plantar. 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