Juanetes o Hallux Valgus

Los juanetes pueden afectar a la calidad de vida ya que influyen directamente en la movilidad.
Infórmate sobre qué puedes hacer si padeces esta patología.

¿QUÉ SON LOS JUANETES?
Los juanetes también se conocen con el nombre más específico de Hallux-valgus. Es una
deformidad de la articulación que une el primer dedo al resto del pie (primera falange a primer
metatarsiano). Produce un abultamiento en esa zona (llamado exóstosis) que hace que
aparezca un callo doloroso con el roce del calzado.

¿POR QUÉ SE PRODUCEN?
Lo más frecuente es por el uso de calzado de punta estrecha y/o calzado demasiado alto
(tacones) durante años.
Existe cierta predisposición familiar (hasta un 70% tienen antecedentes familiares), sobre todo
cuando aparece a edades más jóvenes. Los juanetes en sí no son hereditarios, pero sí que se
hereda la estructura del pie y hay determinados tipos de pies que son más propensos a
desarrollarlos.
Menos frecuentemente se producen por otras enfermedades del pie (artritis reumatoide,
deformidades congénitas…).

¿A QUIÉN AFECTA?
Es más frecuente en mujeres de edad media (40-50 años) por el tipo de calzado que usan.

¿QUÉ SÍNTOMAS PUEDEN APARECER?
Dolor, inflamación y enrojecimiento en la zona de unión del primer dedo con el resto del pie.
Se produce un empeoramiento al caminar o estar mucho tiempo de pie y mejora con el
reposo. Puede aparecer una dureza o callo en esa zona. A veces, se nota sensación de roce o
chasquido al mover el dedo y puede asociar dolor en la planta del pie.
Cuando hay mucha deformidad, se comprimen el resto de dedos del pie que acaban
deformándose también (dedos en garra).
En algunas personas o sobre todo en casos leves, no producen ningún síntoma.

¿CÓMO SE DIAGNOSTICAN?

La historia clínica y la exploración del pie (deformidad) son fundamentales para el diagnóstico.
Además, se pueden realizar radiografías de ambos pies para valorar la severidad y la necesidad
de cirugía.

¿CUÁL ES SU TRATAMIENTO?

Medidas generales

  • Cambiar el calzado. Evite calzado estrecho o de tacón. Es mejor el calzado amplio, que
    no termine en punta, de textura blanda, sin tacón y que no comprima los dedos.
  • Se aconseja comprar el calzado a última hora del día, puesto que el pie suele estar algo
    más hinchado.
  • Evitar actividades que causen dolor, como por ejemplo estar de pie durante largos
    periodos.
  • Proteger con un almohadillado la zona de inflamación y roce.
  • Después de caminar, puede aplicar frío local envuelto en un paño fino.


    Tratamientos farmacológicos
  • Para aliviar el dolor intenso: antiinflamatorios y analgésicos.
  • También puede aplicar antiinflamatorios en la piel en formato crema o gel.


    Tratamientos ortopédicos
  • Existen en el mercado dispositivos ortopédicos para aliviar el dolor (férulas, plantillas,
    separadores interdigitales…). Cuando existe mucha deformidad o dedos en garra, lo
    que más puede aliviar el dolor son plantillas de descarga realizadas a medida previo
    estudio de la pisada.
  • Una función similar tiene los vendajes adhesivos, que, al ser más elásticos y finos,
    permiten llevarlos durante el día.
    Tratamiento quirúrgico
    Realizado por los traumatólogos o podólogos expertos en cirugía cuando los síntomas son
    intensos y no mejoran con las medidas anteriormente descritas. Existen diferentes técnicas
    quirúrgicas para corregir la deformidad del pie y extirpar la “protuberancia”, siempre con el
    objetivo de aliviar el dolor.
    Las infiltraciones con corticoides y la fisioterapia no suelen utilizarse habitualmente en este
    tipo de patología.

¿CUÁNDO CONSULTAR AL MÉDICO?

  • En caso de mala respuesta al tratamiento con analgésicos.
  • Dolor continuo durante más de 15 días.
  • Empeoramiento progresivo de los síntomas.

Sara Leticia de la Fuente Ballesteros
Médico residente, MFyC, Centro de Salud Arturo Eyries, Valladolid


REFERENCIAS:

  • Laffenêtre O, Fourteau C, Darcel V, Chauveaux D. Hallux valgus: definición,
    fisiopatología, exploración física y radiográfica, principios del tratamiento. EMC –
    Podología. 1 de marzo de 2012;14(1):1-11. Disponible en:
    https://www.sciencedirect.com/science/article/abs/pii/S1762827X12610682
  • Ferrari-Portafaix C, Perrier A. Hallux valgus: tratamiento médico y podológico. EMC –
    Podología. 1 de mayo de 2020;22(2):1-9. Disponible en:
    https://clinicalkey.publicaciones.saludcastillayleon.es/#!/content/emc/51-s2.0-
    S1762827X20437022
  • Ramírez Rojas PG. Guía clínica: Patologías frecuentes de tobillo y pie (Internet). La
    Coruña: Fisterra.com. Junio 2018 (citado 14 noviembre de 2020). Disponible en:
    http://www.fisterra.com
  • Olazábal Ulacia JC, Enríquez Gutiérrez EV, García Paniagua R, del Río Pérez P. Averroes:
    manual de terapia en Atención Primaria. EviScience. 2017.
  • Otras páginas web de interés:
    o https://www.semfyc.es/wp-content/uploads/2016/07/14_17.pdf
    o https://www.foothealthfacts.org/conditions/bunions
    o https://www.fisterra.com/m/ficha.asp?idFicha=2245
    o https://medlineplus.gov/spanish/ency/article/001231.htm

Revisado octubre 2020.

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