Arthrosis of the ankle joint is a chronic disease that affects the articular cartilage and, subsequently, other structures of the joint (capsule, synovium, bones, ligaments). It has a degenerative-dystrophic character. It manifests as pain and limitation of movement, followed by progressive impairment of support and gait functions. The diagnosis is made based on symptoms, exams and x-rays. Treatment is generally conservative, with the use of anti-inflammatories, chondroprotectors and glucocorticoids, in addition to prescribing physical exercises and physiotherapy. In severe cases, sanitary arthroscopy, arthrodesis or endoprosthesis are performed.
General information
Arthrosis of the ankle joint is a disease in which the articular cartilage and surrounding tissues are gradually destroyed. The disease is based on degenerative-dystrophic processes, inflammation in the joint is secondary. Osteoarthritis has a chronic wave-like course, with alternating remissions and exacerbations, and progresses gradually. Women and men suffer equally often. The likelihood of development increases markedly with age. At the same time, experts note that the disease is "getting younger" - every third case of ankle arthrosis is currently detected in people under 45 years of age.
Causes
Primary osteoarthritis occurs for no apparent reason. Secondary damage to the ankle joint develops under the influence of some unfavorable factors. In both cases, the basis is a violation of metabolic processes in cartilaginous tissue. The main causes and predisposing factors for the formation of secondary arthrosis of the ankle joint are:
- major intra- and periarticular injuries (talus fractures, ankle fractures, ligament ruptures and ruptures);
- ankle surgery;
- excessive load: very intense sports, long walks or standing due to working conditions;
- wearing shoes with heels, being overweight, constant microtraumas;
- diseases and conditions associated with metabolic disorders (diabetes mellitus, gout, pseudogout, postmenopausal estrogen deficiency);
- rheumatic diseases (SLE, rheumatoid arthritis);
- osteochondrosis of the lumbar spine, intervertebral hernia and other conditions that are accompanied by pinched nerves and disruption of the muscular system of the foot and leg.
Less commonly, the cause of arthrosis is nonspecific purulent arthritis, arthritis due to specific infections (tuberculosis, syphilis) and congenital developmental anomalies. Unfavorable environmental conditions and hereditary predisposition play a certain role in the development of arthrosis.
Pathogenesis
Normally, the articular surfaces are smooth, elastic, smoothly slide relative to each other during movements and provide effective shock absorption under load. As a result of mechanical damage (trauma) or metabolic disorders, cartilage loses its smoothness, becomes rough and inelastic. Cartilages "rub" during movements and get injured, which leads to an aggravation of pathological changes.
Due to insufficient depreciation, excess load is transferred to the underlying bone structure, and degenerative-dystrophic disorders also develop in it: the bone is deformed and grows along the edges of the articular area. Due to secondary trauma and disruption of the normal biomechanics of the joint, not only the cartilage and bone suffer, but also the surrounding tissues.
The joint capsule and synovial membrane thicken and foci of fibrous degeneration form in the periarticular ligaments and muscles. The ability of the joint to participate in movements and bear loads decreases. Instability occurs and the pain progresses. In severe cases, the articular surfaces are destroyed, the supporting function of the limb is impaired, and movement becomes impossible.
Symptoms
Initially, after a significant load, rapid fatigue and mild pain in the ankle joint are detected. Subsequently, the pain syndrome becomes more intense, its nature and time of occurrence change. The distinctive features of pain with osteoarthritis are:
- Initial pain. They appear after a state of rest and gradually disappear with movement.
- Load dependency. There is increased pain during exercise (standing, walking) and rapid fatigue of the joint.
- Night pain. They usually appear in the morning.
The condition changes in waves, during exacerbations the symptoms are more pronounced, in the remission phase they first disappear, then become less intense. There is a gradual progression of symptoms over several years or decades. Along with pain, the following manifestations are determined:
- When moving, grinding, squeaking or clicking noises may occur.
- During an exacerbation, the periarticular area sometimes swells and turns red.
- Due to the instability of the joint, the patient often twists the leg, causing sprains and ligament tears.
- Stiffness and limited movement are observed.
Complications
During an exacerbation, reactive synovitis may occur, accompanied by fluid accumulation in the joint. In the later stages, pronounced deformation is revealed. Movements are clearly limited and contractures develop. Support becomes difficult; when moving, patients are required to use crutches or a cane. There is a decrease or loss of working capacity.
Diagnosis
The diagnosis of arthrosis of the ankle joint is made by an orthopedic doctor based on research, data from external examinations and the results of additional studies. When examined in the initial stages, there may be no changes, but later deformations, limitation of movements and pain on palpation are revealed. The main importance is given to visualization techniques:
- X-ray of the ankle joint. It plays a decisive role in the diagnosis and determination of the degree of osteoarthritis. Pathology is indicated by narrowing of the joint space, proliferation of the edges of the articular surfaces (osteophytes). At a later stage, cystic formations and osteosclerosis of the subchondral zone (located under the cartilage) of the bone are detected.
- Tomographic studies. Used when indicated. In difficult cases, for a more accurate assessment of the state of bone structures, the patient is additionally referred for a CT scan, and for examination of soft tissues - for an MRI of the ankle joint.
Laboratory tests remain unchanged. If necessary, to establish the cause of arthrosis and differential diagnosis with other diseases, consultations with related specialists are prescribed: neurologist, rheumatologist, endocrinologist.
Treatment of ankle osteoarthritis
Treatment of the pathology is long and complex. Patients are usually seen by an orthopedic surgeon on an outpatient basis. During the period of exacerbation, hospitalization in the traumatology and orthopedics department is possible. The most important role in slowing down the progression of arthrosis is played by the lifestyle and the correct mode of physical activity, which is why the patient is given recommendations for losing weight and optimizing the load on the leg.
Drug therapy
It is selected individually, taking into account the stage of arthrosis, the severity of symptoms and concomitant diseases. Includes general and local agents. The following groups of medicines are used:
- General NSAIDs. Tablet formats are generally used. Medicines have a negative effect on the gastric mucosa, therefore, for gastrointestinal diseases, "mild" medicines are preferable.
- Local NSAIDs. Recommended both during the period of exacerbation and in the remission phase. It can be prescribed as an alternative if side effects from the tablets occur. Available in the form of ointments and gels.
- Chondroprotectors. Substances that help normalize metabolic processes in cartilaginous tissue. They are used in the form of creams, gels and preparations for intra-articular administration. Use medications that contain glucosamine and hydrolyzed collagen.
- Hormonal agents. In cases of severe pain that cannot be relieved with medication, intra-articular corticosteroids are administered a maximum of 4 times a year.
- Metabolic stimulants. To improve local blood circulation and activate tissue metabolism, nicotinic acid is prescribed.
Physiotherapy treatment
The patient is prescribed a physiotherapy complex, developed taking into account the manifestations and stage of the disease. The patient is referred to physical therapy. In the treatment of osteoarthritis, massages and UHF are used. In addition, in the treatment of pathology they use:
- laser therapy;
- thermal procedures;
- medicinal electrophoresis and ultraphonophoresis.
Surgery
Indicated in the later stages of the disease, when conservative therapy is ineffective, severe pain syndrome, deterioration in patients' quality of life or limited ability to work. The operations are carried out in a hospital environment and are open and minimally invasive:
- Arthroscopic interventions. If there is significant cartilage destruction, arthroscopic chondroplasty is performed. Sanitation arthroscopy (removal of formations that impede movement) is usually performed for severe pain in stage 2 arthrosis. The effect lasts for several years.
- Arthrodesis of the ankle joint. It is carried out in case of significant destruction of the articular surfaces, involves removing the joint and "fusion" of the bones of the foot and leg. Provides restoration of the support function of the limb in case of loss of joint mobility.
- Endoprosthesis of the ankle joint. Performed for advanced osteoarthritis. It involves removing the destroyed articular surfaces of the bones and replacing them with plastic, ceramic or metal prostheses. Movements are fully restored, the service life of the prosthesis is 20-25 years.
Forecast
Changes in the joint are irreversible, but the slow progression of arthrosis, timely initiation of treatment and compliance with the recommendations of an orthopedic traumatologist in most cases make it possible to maintain working capacity and a high quality of life for decades after the appearance of the first symptoms. With the rapid increase in pathological changes, endoprosthesis makes it possible to avoid disabilities.
Prevention
Preventive measures include reducing the level of injuries, especially in winter during periods of ice. If you are obese, you need to take steps to reduce your body weight to lessen the load on the joint. A regime of moderate physical activity must be maintained, avoid overloads and microtraumas and promptly treat diseases that can trigger the development of osteoarthritis of the ankle joint.