{"id":602,"date":"2019-09-26T23:34:49","date_gmt":"2019-09-27T04:34:49","guid":{"rendered":"https:\/\/www.drestebancastro.com\/blog\/?p=602"},"modified":"2026-07-05T07:15:11","modified_gmt":"2026-07-05T13:15:11","slug":"tratamiento-del-pie-de-charcot-2","status":"publish","type":"post","link":"https:\/\/www.drestebancastro.com\/blog\/tratamiento-del-pie-de-charcot-2\/","title":{"rendered":"Tratamiento del pie de Charcot"},"content":{"rendered":"\n<div class=\"wp-block-rank-math-toc-block\" id=\"rank-math-toc\"><h2>Table of Contents<\/h2><nav><ul><li><a href=\"#tratamiento-del-pie-de-charcot\">Tratamiento del pie de Charcot<\/a><ul><li><a href=\"#serie-de-casos\">Serie de casos<\/a><\/li><li><a href=\"#objetivo\">Objetivo<\/a><\/li><li><a href=\"#material-y-metodo\">Material y m\u00e9todo<\/a><\/li><li><a href=\"#tratamiento-del-pie-de-charcot-1\">Tratamiento del pie de Charcot <\/a><ul><li><a href=\"#tratamientodelpiede-charcot\">#TratamientodelpiedeCharcot <\/a><\/li><\/ul><\/li><\/ul><\/li><\/ul><\/nav><\/div>\n\n\n\n<h1 class=\"wp-block-heading\" id=\"tratamiento-del-pie-de-charcot\"><a href=\"https:\/\/www.drestebancastro.com\/blog\/2019\/09\/26\/tratamiento-del-pie-de-charcot-2\/\"><strong>Tratamiento del pie de Charcot<\/strong><\/a><\/h1>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.drestebancastro.com\/blog\/2019\/09\/26\/tratamiento-del-pie-de-charcot-2\/\"><strong>Tratamiento del pie de Charcot<\/strong><\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><a href=\"https:\/\/www.drestebancastro.com\/blog\/2019\/09\/26\/tratamiento-del-pie-de-charcot-2\/\">Tratamiento del pie de Charcot<\/a> complejo mediante <a href=\"https:\/\/www.drestebancastro.com\/blog\/2019\/09\/26\/tratamiento-del-pie-de-charcot-2\/\">cirug\u00eda<\/a> en un solo tiempo con <a href=\"https:\/\/www.drestebancastro.com\/blog\/2019\/09\/26\/tratamiento-del-pie-de-charcot-2\/\">fijador circular est\u00e1tico<\/a>. <\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"serie-de-casos\"><strong>Serie de casos<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">El <a href=\"https:\/\/www.drestebancastro.com\/blog\/2019\/09\/26\/tratamiento-del-pie-de-charcot-2\/\">pie de Charcot<\/a>, consecuencia de la <a href=\"https:\/\/www.drestebancastro.com\/blog\/2019\/09\/26\/tratamiento-del-pie-de-charcot-2\/\">neuropat\u00eda<\/a> diab\u00e9tica, es un proceso inflamatorio con diferentes grados de destrucci\u00f3n \u00f3sea y deformidad. Su prevalencia ronda el 7,5% de todos los pacientes diab\u00e9ticos y el 9-35% de estos pacientes presentar\u00e1n una lesi\u00f3n bilateral; estos pacientes, con o sin infecci\u00f3n \u00f3sea, suponen adem\u00e1s un alto gasto econ\u00f3mico para los sistemas sanitarios.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">En el <a href=\"https:\/\/www.drestebancastro.com\/blog\/2019\/09\/26\/tratamiento-del-pie-de-charcot-2\/\">pie de Charcot<\/a>, la p\u00e9rdida de sensibilidad protectora y el alto recambio \u00f3seo local se acompa\u00f1an de una carga repetida sobre las estructuras lesionadas durante la marcha normal. La suma de estos elementos provoca un pie fr\u00e1gil e insensible. El diagn\u00f3stico en fase activa suele ser cl\u00ednico (<a href=\"https:\/\/www.drestebancastro.com\/blog\/2019\/09\/26\/tratamiento-del-pie-de-charcot-2\/\">neuropat\u00eda<\/a> distal, aumento de volumen y enrojecimiento del pie), mientras que en la fase no activa destacan las deformidades caracter\u00edsticas, como el pie en balanc\u00edn y las deformidades axiales del tobillo. En su an\u00e1lisis radiogr\u00e1fico, <em>Wukich et al<\/em>. Establece un l\u00edmite de 27 grados de alteraci\u00f3n en la l\u00ednea de Meary como predictor de la aparici\u00f3n de <a href=\"https:\/\/www.drestebancastro.com\/blog\/2019\/09\/26\/tratamiento-del-pie-de-charcot-2\/\">\u00falcera<\/a>s. La clasificaci\u00f3n de Eichenholtz define el estadio cl\u00ednico y la clasificaci\u00f3n de Brodsky sit\u00faa anat\u00f3micamente la lesi\u00f3n, siendo el medio-pi\u00e9 la zona m\u00e1s com\u00fanmente afectada. Recientemente, se propone simplemente dividir al <a href=\"https:\/\/www.drestebancastro.com\/blog\/2019\/09\/26\/tratamiento-del-pie-de-charcot-2\/\">pie de Charcot<\/a> en activo o inactivo. La <a href=\"https:\/\/www.drestebancastro.com\/blog\/2019\/09\/26\/tratamiento-del-pie-de-charcot-2\/\">amputaci\u00f3n<\/a> es la complicaci\u00f3n m\u00e1s importante a evitar por su alta mortalidad y existe evidencia de que es m\u00e1s econ\u00f3mico reconstruir quir\u00fargicamente que amputarles. Por esto, el objetivo del <a href=\"https:\/\/www.drestebancastro.com\/blog\/2019\/09\/26\/tratamiento-del-pie-de-charcot-2\/\">tratamiento<\/a> es conseguir un pie plant\u00edgrado y funcional, con estabilidad estructural.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">El <a href=\"https:\/\/www.drestebancastro.com\/blog\/2019\/09\/26\/tratamiento-del-pie-de-charcot-2\/\">tratamiento<\/a> no quir\u00fargico es efectivo en un 60% de los casos. El <a href=\"https:\/\/www.drestebancastro.com\/blog\/2019\/09\/26\/tratamiento-del-pie-de-charcot-2\/\">tratamiento<\/a> quir\u00fargico se indicaba en raras ocasiones por sus resultados poco predecibles. En la actualidad, existe evidencia de que el <a href=\"https:\/\/www.drestebancastro.com\/blog\/2019\/09\/26\/tratamiento-del-pie-de-charcot-2\/\">tratamiento<\/a> quir\u00fargico temprano puede tener mejores resultados con una correcci\u00f3n y estabilizaci\u00f3n de la deformidad. La pobre calidad \u00f3sea en los diab\u00e9ticos parece ser un factor determinante en el fracaso de la fijaci\u00f3n interna. Por esto <em>Sammarco et al<\/em>. Propusieron las s\u00faper-construcciones, que recientemente se realizan con placas espec\u00edficas. La presencia de procesos infecciosos \u00f3seos y de partes blandas, y el precario estado cut\u00e1neo tambi\u00e9n pueden contraindicar la osteos\u00edntesis interna.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"objetivo\"><strong>Objetivo<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Resultados de casos de <a href=\"https:\/\/www.drestebancastro.com\/blog\/2019\/09\/26\/tratamiento-del-pie-de-charcot-2\/\">pie de Charcot<\/a> tratados por <a href=\"https:\/\/www.drestebancastro.com\/blog\/2019\/09\/26\/tratamiento-del-pie-de-charcot-2\/\">cirug\u00eda<\/a> en un solo tiempo con <a href=\"https:\/\/www.drestebancastro.com\/blog\/2019\/09\/26\/tratamiento-del-pie-de-charcot-2\/\">fijador circular est\u00e1tico<\/a>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"material-y-metodo\"><strong>Material y m\u00e9todo<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Revisi\u00f3n retrospectiva de 10 casos tratados con fijaci\u00f3n externa circular est\u00e1tica desde 2016,<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">-Criterios de inclusi\u00f3n:&nbsp;<em>1)<\/em>&nbsp;deformidad asociada a alguno de los siguientes signos: <a href=\"https:\/\/www.drestebancastro.com\/blog\/2019\/09\/26\/tratamiento-del-pie-de-charcot-2\/\">\u00falcera<\/a> cut\u00e1nea, <a href=\"https:\/\/www.drestebancastro.com\/blog\/2019\/09\/26\/tratamiento-del-pie-de-charcot-2\/\">osteomielitis<\/a> o inestabilidad articular;&nbsp;<em>2)<\/em>&nbsp;<a href=\"https:\/\/www.drestebancastro.com\/blog\/2019\/09\/26\/tratamiento-del-pie-de-charcot-2\/\">neuropat\u00eda<\/a> perif\u00e9rica, y&nbsp;<em>3)<\/em>&nbsp;fallo del tratamiento ortop\u00e9dico previo.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">-Criterios de exclusi\u00f3n:&nbsp;<em>1)<\/em>&nbsp;obstrucci\u00f3n vascular perif\u00e9rica sin revascularizar;&nbsp;<em>2)<\/em>&nbsp;incapacidad para cumplir el <a href=\"https:\/\/www.drestebancastro.com\/blog\/2019\/09\/26\/tratamiento-del-pie-de-charcot-2\/\">tratamiento<\/a>;&nbsp;<em>3)<\/em>&nbsp;pacientes no deambulantes, y&nbsp;<em>4) <\/em>contraindicaci\u00f3n m\u00e9dica para la <a href=\"https:\/\/www.drestebancastro.com\/blog\/2019\/09\/26\/tratamiento-del-pie-de-charcot-2\/\">cirug\u00eda<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">De los 10 pacientes, 7&nbsp;hombres y 3 mujeres, 6 ten\u00edan afectaci\u00f3n del pie izquierdo y 4 del derecho. La edad promedio de nuestros pacientes era de 58 a\u00f1os (rango 39-71). Se valoro estadio de Eichenholtz, clasificaci\u00f3n de Brodsky, presencia de <a href=\"https:\/\/www.drestebancastro.com\/blog\/2019\/09\/26\/tratamiento-del-pie-de-charcot-2\/\">\u00falcera<\/a>s cut\u00e1neas, <a href=\"https:\/\/www.drestebancastro.com\/blog\/2019\/09\/26\/tratamiento-del-pie-de-charcot-2\/\">osteomielitis<\/a> e inestabilidad. Todos los pacientes fueron tratados con fijaci\u00f3n circular con un seguimiento medio de 17 meses (rango 11-24 meses). Postoperatoriamente, se valoro la conservaci\u00f3n de la extremidad, curaci\u00f3n de la <a href=\"https:\/\/www.drestebancastro.com\/blog\/2019\/09\/26\/tratamiento-del-pie-de-charcot-2\/\">\u00falcera<\/a> cut\u00e1nea, estabilidad e \u00edndice de re-ulceraciones.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Resultados<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">En todos los pacientes se consigui\u00f3 un pie plant\u00edgrado funcional, curaci\u00f3n de <a href=\"https:\/\/www.drestebancastro.com\/blog\/2019\/09\/26\/tratamiento-del-pie-de-charcot-2\/\">\u00falcera<\/a> cut\u00e1nea sin recidiva. Cuatro casos presentaron infecci\u00f3n cut\u00e1nea en las agujas, resuelta con cuidados locales. Rotura de aguja en 2 casos, que no requirieron recambio. Todos los pacientes est\u00e1n satisfechos y optar\u00edan por la misma t\u00e9cnica, de ser necesario.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Conclusiones<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">En el <a href=\"https:\/\/www.drestebancastro.com\/blog\/2019\/09\/26\/tratamiento-del-pie-de-charcot-2\/\">pie de Charcot<\/a> los objetivos son evitar la <a href=\"https:\/\/www.drestebancastro.com\/blog\/2019\/09\/26\/tratamiento-del-pie-de-charcot-2\/\">amputaci\u00f3n<\/a> y conseguir un pie plant\u00edgrado funcional, sin <a href=\"https:\/\/www.drestebancastro.com\/blog\/2019\/09\/26\/tratamiento-del-pie-de-charcot-2\/\">\u00falcera<\/a> cut\u00e1nea. La <a href=\"https:\/\/www.drestebancastro.com\/blog\/2019\/09\/26\/tratamiento-del-pie-de-charcot-2\/\">cirug\u00eda<\/a> en un solo tiempo con fijaci\u00f3n externa circular est\u00e1tica es una t\u00e9cnica reproducible en nuestro medio, v\u00e1lida adem\u00e1s para aquellos casos en que la fijaci\u00f3n interna puede estar contraindicada.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>REFERENCIAS<\/strong><\/p>\n\n\n\n<ol class=\"wp-block-list\"><li>Rios Ruh, J. M., L\u00f3pez Capdevila, L., Dom\u00ednguez Sevilla, A., Roman Verdasco, J., Santamar\u00eda Fumas, A., &amp; Sales P\u00e9rez, J. M. (2019). <em><a href=\"https:\/\/www.drestebancastro.com\/blog\/2019\/09\/26\/tratamiento-del-pie-de-charcot-2\/\">Tratamiento<\/a> del <a href=\"https:\/\/www.drestebancastro.com\/blog\/2019\/09\/26\/tratamiento-del-pie-de-charcot-2\/\">pie de Charcot<\/a> complejo mediante <a href=\"https:\/\/www.drestebancastro.com\/blog\/2019\/09\/26\/tratamiento-del-pie-de-charcot-2\/\">cirug\u00eda<\/a> en un solo tiempo con <a href=\"https:\/\/www.drestebancastro.com\/blog\/2019\/09\/26\/tratamiento-del-pie-de-charcot-2\/\">fijador circular est\u00e1tico<\/a>. Serie de casos.&nbsp;Revista Espa\u00f1ola de <a href=\"https:\/\/www.drestebancastro.com\/blog\/2019\/09\/26\/tratamiento-del-pie-de-charcot-2\/\">Cirug\u00ed<\/a>a Ortop\u00e9dica y Traumatolog\u00eda,&nbsp;63(1), 41\u201348. https:\/\/doi.org\/10.1016\/j.recot.2018.05.002<\/em><\/li><\/ol>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"tratamiento-del-pie-de-charcot-1\"><a href=\"https:\/\/www.drestebancastro.com\/blog\/2019\/09\/26\/tratamiento-del-pie-de-charcot-2\/\"><strong>Tratamiento del pie de Charcot <\/strong><\/a><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"tratamientodelpiede-charcot\"><a href=\"https:\/\/es-la.facebook.com\/pages\/category\/Medical-Center\/Dr-Esteban-Castro-Contreras-Traumat%C3%B3logo-y-Ortopedista-121291695221565\/\" target=\"_blank\" rel=\"noopener\"><em><strong>#TratamientodelpiedeCharcot <\/strong><\/em><\/a><\/h3>\n\n\n\n<div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button has-custom-width 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