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espanolIntroduccion: La metatarsalgia por insuficiencia de primer radio es una de las patologias mas frecuentes del pie, cuyo protocolo de tratamiento no esta bien establecido. El objetivo de este estudio prospectivo es valorar un protocolo de actuacion, y considerar diferentes factores etiologicos que influyen en la patologia y los resultados del tratamiento. Pacientes y metodo: Se valoraron pacientes diagnosticados de metatarsalgia por insuficiencia del primer radio, diagnosticados por radiologia simple y estudio biomecanico, evaluando las presiones plantares y el dolor, funcion y alineacion mediante la escala American Orthopedic Foot and Ankle Surgery (AOFAS) al inicio y despues de cada tratamiento; aplicando el tratamiento con soportes plantares personalizados con barra metatarsal y extension de Morton, a los 3 meses segun la efectividad, infiltracion con corticoides, evaluando al paciente a los 6 meses y, en caso de fracaso de los dos anteriores, se indico el tratamiento quirurgico utilizando la osteotomia de Weil. Seguimiento de cada a paciente a un ano, observando que variables pueden influir en la patologia. Resultados: La muestra final fue de 56 pacientes: 46 permanecieron asintomaticos mediante soportes plantares, 10 precisaron soportes plantares e infiltracion con corticoides, de los cuales 4 dejaron de tener dolor y 6, al ser inefectivos los anteriores tratamientos, fueron sometidos a la cirugia. Discusion: Tres variables fueron significativas asociadas a la metatarsalgia antes de aplicar cualquier tratamiento (indice de masa corporal, patologias asociadas, inestabilidad de la articulacion metatarsofalangica afectada) y la variable prevalente despues del tratamiento de infiltracion y cirugia fue cirugia previa. EnglishIntroduction: Metatarsalgia for first ray insufficiency is one of the most common pathologies of the foot, whose treatment protocol is not well established. The objective of this prospective study is to assess a protocol of treatment, and to consider different factors that influence the pathology and treatment results. Patients and method: Patients diagnosed with metatarsalgia for first ray insufficiency diagnosed through simple radiology and biomechanical study were prospectively assessed, evaluating plantar pressures and pain, function and alignment using the American Orthopedic Foot and Ankle Surgery (AOFAS) scale at the beginning and after each treatment; first applying the treatment with personalized plantar supports with metatarsal bar, at 3 months according to effectiveness, infiltration with corticosteroids, evaluating the patient at 6 months and, in case of failure of the previous two, the treatment was indicated using Weil’s osteotomy. Follow-up of each patient to one year, observing that variables can influence the pathology. Results: The final sample was of 56 patients, of whom 46 remained asymptomatic by plantar supports, 10 patients needed plantar supports and infiltration with corticosteroids, of which 4 ceased to have pain and 6 patients the previous treatments were ineffective, they underwent surgery. Discussion: Three variables were significant associated with metatarsalgia before applying any treatment (Body Mass Index, associated pathologies, affected metatarsal-phalagic joint instability) and the 2 prevalent variables after applying the infiltration Recibido: 01-05-2019 and surgery treatment were previous surgery and insufficiency of first iatrogenic ray.

revista española de podología/revista española de podología

Evaluación prospectiva de un protocolo actuación para la metatarsalgia por insuficiencia de primer radio: Resultados de tratamiento conservador y quirúrgico