Osteoarthritis 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 itself with pain and limitation of movement, followed by progressive impairment of support and walking functions. The diagnosis is made based on symptoms, physical examination and x-ray. Treatment is usually conservative, using anti-inflammatory drugs, chondroprotectors and glucocorticoids and prescribing exercise and physical therapy. In more serious cases, medical arthroscopy, arthrodesis or endoprosthesis are performed.
general informations
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 of the joint is secondary. Osteoarthritis has a chronic undulating course with alternating remissions and exacerbations and progresses gradually. Women and men suffer equally often. The likelihood of development increases significantly with age. At the same time, experts note that the disease is "getting younger": currently a third case of ankle arthrosis is 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 the cartilage tissue. The main causes and predisposing factors for the formation of secondary arthrosis of the ankle joint are:
- serious intra- and periarticular injuries (fractures of the talus, fractures of the ankle, tears and ruptures of the ligaments);
- ankle surgery;
- excessive load: too intense sports, long walks or constant standing position due to working conditions;
- wearing high-heeled shoes, excess weight, 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 accompanied by pinching of the 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 joint surfaces are smooth, elastic, slide smoothly relative to each other during movements and provide effective shock absorption under load. Due to mechanical damage (trauma) or metabolic disorders, cartilage loses its smoothness, becomes rough and inelastic. The cartilage "rubs" during movements and injures each other, which leads to a worsening of pathological changes.
Due to insufficient depreciation, the excess load is transferred to the underlying bone structure, and degenerative-dystrophic disorders also develop in it: the bone deforms and grows along the edges of the joint 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 joint's ability to participate in movements and bear loads decreases. Unsteadiness occurs and pain progresses. In more severe cases, the joint surfaces are destroyed, the support function of the limb is compromised and movements become impossible.
Symptoms
Initially, rapid fatigue and mild pain in the ankle joint are detected after significant load. Subsequently, the pain syndrome becomes more intense, its nature and the time of its manifestation change. Distinctive features of pain with osteoarthritis are:
- Initial pain. They appear after a state of rest and then gradually disappear with movement.
- Load dependence. 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:
- There may be creaks, squeaks or clicks while moving.
- During a flare-up, the periarticular area sometimes swells and turns red.
- Due to the instability of the joint, the patient often twists the leg, causing sprains and torn ligaments.
- Stiffness and limitation of movement are noted.
Complications
Reactive synovitis may occur during a flare-up, accompanied by fluid accumulation in the joint. In later stages, pronounced deformation is revealed. Movements are markedly limited and contractures develop. Support becomes difficult; when moving, patients are forced to use crutches or a cane. There is a decrease or loss of working capacity.
Diagnostics
The diagnosis of arthrosis of the ankle joint is made by an orthopedic doctor based on a survey, external examination data and the results of further studies. On examination in the early stages, there may be no changes, but later deformations, limitation of movement 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. The pathology is indicated by narrowing of the joint space, proliferation of the edges of the joint surfaces (osteophytes). At a later stage, cystic formations and osteosclerosis of the subchondral area (located under the cartilage) of the bone are detected.
- Tomographic studies. Used when indicated. In difficult cases, for a more accurate assessment of the condition of the bone structures, the patient is additionally sent to a computed tomography scan, and to examine soft tissues - to 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 arthritis
Treatment of the disease is long-term 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 the progression of arthrosis is played by lifestyle and the correct mode of physical activity, therefore the patient is given recommendations for weight loss and optimization of the load on the leg.
Pharmacological 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 drugs are used:
- General NSAIDs. Tablet modules are usually used. Drugs have a negative effect on the gastric mucosa, so for gastrointestinal diseases "gentle" drugs are preferable.
- Local NSAIDs. Recommended both during the flare-up period and in the remission phase. It can be prescribed as an alternative if you experience side effects of the tablets. Available in the form of ointments and gels.
- Chondroprotectors. Substances that help normalize metabolic processes in cartilage tissue. They are used in the form of creams, gels and preparations for intra-articular administration. Use drugs containing glucosamine and hydrolyzed collagen.
- Hormonal agents. In case of severe pain that cannot be relieved with drugs, intra-articular corticosteroids are administered no more than 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 complex of physical therapy, developed taking into account the manifestations and stage of the disease. The patient is referred to physiotherapy. In the treatment of arthrosis, massage 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 of patients' quality of life or limited working capacity. The operations are performed in a hospital setting and are open and minimally invasive:
- Arthroscopic interventions. If there is significant cartilage destruction, arthroscopic chondroplasty is performed. Health arthroscopy (removal of formations that impede movement) is usually performed for severe pain at stage 2 of arthrosis. The effect lasts for several years.
- Arthrodesis of the ankle joint. It is performed in case of significant destruction of the joint surfaces, involves the removal of the joint and the "fusion" of the bones of the foot and lower 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 articulating surfaces of the bones and replacing them with plastic, ceramic or metal prosthetics. Movements are fully restored, the 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 allow you to maintain working capacity and a high quality of life for decades after the first symptoms appeared. With a rapid increase in pathological changes, the endoprosthesis allows you to avoid disability.
Prevention
Preventive measures include reducing the level of injuries, especially in winter, during icy periods. If you are obese, you need to take steps to reduce body weight to reduce the load on the joint. You should maintain a regime of moderate physical activity, avoid overloads and microtraumas, and timely treat diseases that can trigger the development of arthrosis of the ankle joint.