El Músculo Tibial Posterior posee un potente tendón que discurre por detrás del maléolo interno o tibial del tobillo para insertarse en el borde interno del pie, especialmente en el hueso Escafoides. Es un tendón de una relevancia muy importante para caminar y estar de pie. Realiza la función de flexión plantar del pie e inversión del tobillo, siendo fundamental para estabilizar el pie cuando nos ponemos de puntillas.

Las lesiones de este tendón originan dolor e incapacidad para caminar correctamente.  En algunos casos tenemos roturas parciales o totales del mismo, sobre todo en el contexto degenerativo del tendón que recibe el nombre de tendinosis.

Si el problema se ha instaurado lentamente y poco a poco, lo calificamos como Insuficiencia del Tendón Tibial Posterior, que consiste en la perdida su función de forma progresiva, teniendo como consecuencia un Pie Plano Adquirido del Adulto.

El dolor suele situarse por detrás del maleolo interno, donde el tendón se dirige a la punta del pie. Existe dificultad en la exploración para que el paciente haga una elevación de puntillas con el pie afectado.

Este proceso se presenta con mayor frecuencia de modo unilateral (en un solo pie) y el paciente en muchas ocasiones relata que ha tenido un esguince mal curado previo y esta viendo como el arco de su pie se hunde en exceso.

 

En todas las alteraciones del aparato locomotor es importante el diagnóstico precoz, pero en esta de un modo todavía mas importante ya que no empezar a tratar precozmente de modo conservador en esta patología tiene unas consecuencias drásticas de hundimiento para el pie.

El problema radica en que una vez lesionado, el tendón del tibial posterior no es capaz de curarse por que  cada paso que damos lo vuelve a lesionar.

Aquellos pacientes que tratamos en los primeros estadíos se recuperan sin problema con el uso de ortesis plantares.

¿Que debo observar para preocuparme?

Uno de sus pies se esta hundiendo en exceso en un periodo relativamente corto.
Tiene dolor en la cara interna del tobillo
Es incapaz de ponerse de puntillas con ese pie.

¿Que podemos hacer?

Realizaremos una exploracion biomecanica para ver los factores mecánicos que están influyendo en la lesión, con un tratamiento mecánico correcto conseguimos minimizar el trabajo que tiene que realizar el tendón y conseguir de este modo la mejoría de la lesión y su posterior curación.

Es muy importante en este tipo de lesiones no esperar para instaurar el tratamiento conservador por que el pronóstico empeora a medida que el pie se colapsa.

 

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