Diagnosi strumentale di fascite plantare

La fascite plantare è l’infiammazione di uno spesso tessuto sulla parte inferiore del piede. Questo tessuto viene chiamato fascia plantare e collega il calcagno alle dita del piede creando l’arco del piede.

Cause, incidenza e fattori di rischio

La fascite plantare si verifica quando la banda spessa di tessuto sulla parte inferiore del piede (la fascia plantare) è troppo tesa o stressata dal troppo carico. Questo può creare dolore e rendere più difficile il camminare. La fascite plantare è un problema molto comune degli atleti soprattutto in quelli amatoriali che praticano la corsa.

Si hanno maggiori probabilità di ammalarsi di fascite plantare se:

  • Si hanno problemi all’arco del piede (entrambi i piedi piatti o cavi -troppo arcuati-)
  • Si corre su lunghe distanze, specialmente in discesa o su superfici irregolari
  • Improvviso aumento di peso o obesità
  • Si soffre di tendinite del tendine d’Achille (il tendine che collega i muscoli del polpaccio al tallone)
  • Si utilizzano scarpe non adeguate, con plantare scarso o con la suola troppo morbida

SPINA CALCANEARE

E’ una  esostosi causata dall’infiammazione della fascia plantare a livello dell’inserzione sul tallone (entesopatia), con conseguente deposito di sali di calcio. A lungo termine, l‘accumulo di calcio a livello del tallone provoca la formazione della spina calcaneare.

Comunemente si pensa che la fascite plantare sia causata da un sperone calcaneare, ma studi scientifici hanno dimostrato che questo non è vero. Infatti molto spesso il riscontro della spina calcanerae avviene casualmente in pazienti che effettuano l’esame radiografica per la ricerca di altre patologie e che non riferiscono al radiologo alcun dolore sotto il calcagno.  Nel caso dello sportivo tale convivenza asintomatica è più difficile perché la spina fa aumentare le probabilità che si infiammi la fascia plantare che si inserisce sul tallone.

All’esame radiografico, la spina calcaneare si può osservare in proiezione laterale ; la grandezza dello sperone calcaneare generalmente non è proporzionale all’entità della patologia ma da l’idea di quanto la porzione sottocalcaneare sia stata sollecitata nel tempo, per cause posturali e/o di sovraccarico sportivo.

In pazienti sintomatici (dolore sotto al calcagno, risulta indicata l’esecuzione di un esame ecografico con sonda ad alta frequenza al fine di dimostrare direttamento lo stato infiammatorio  dell’aponeurosi (fascia) e la sua eventuale lesione.

La RM è indicata solo quando, specie negli sportivi agonisti, si vogliae scludere la sovrapposizione flogistica dell’osso calcaneare inferiore,  non visibile con RX ed ecografia, la cui eventuale presenza allungherebbe i tempi di guarigione.

La RM è assolutamente indicata in pazienti sintomatici qualora in ecografia non si riscontrino alterazioni significative a carico della fascia plantare; nel caso della diapositiva sottostante vediamo infatti come posso emergere all’esame RM una patologia insospettata come la frattura intrapongiosa del calcagno da sovraccarico compartimentale (tennista).

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