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 itself as pain and limitation of movements, followed by progressive impairment of the functions of support and walking. The diagnosis is made based on symptoms, examination and radiography. Treatment is usually conservative, using anti-inflammatory drugs, chondroprotectors and glucocorticoids, and prescribing exercise therapy and physical therapy. In severe cases, sanitary arthroscopy, arthrodesis or endoprosthetics 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. Arthrosis has a chronic wave-like course with alternating remissions and exacerbations, and gradually progresses. Women and men suffer equally often. The likelihood of development increases sharply 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 arthrosis occurs without any 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 cartilage tissue. The main causes and predisposing factors for the formation of secondary arthrosis of the ankle joint are:
- major intra- and periarticular injuries (fractures of the talus, ankle fractures, tears and ruptures of ligaments);
- ankle surgery;
- excessive load: too intense sports, long walking or constant standing due to working conditions;
- wearing shoes with heels, excess weight, constant microtraumas;
- diseases and conditions associated with metabolic disorders (diabetes mellitus, gout, pseudogout, estrogen deficiency in postmenopause);
- 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, slide smoothly 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. Cartilage "rubs" during movements and injures each other, which leads to worsening 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 ligaments and periarticular muscles. The ability of the joint to participate in movements and withstand loads decreases. Instability occurs and pain progresses. In severe cases, the articular surfaces are destroyed, the supporting function of the limb is impaired, and movements become impossible.
Symptoms
Initially, rapid fatigue and mild pain in the ankle joint are detected after a significant load. Subsequently, the pain syndrome becomes more intense, its nature and time of occurrence change. Distinctive features of pain with arthrosis are:
- Starting pain. Appear after a state of rest, and then gradually disappear with movement.
- Dependence on load. There is increased pain during exercise (standing, walking) and rapid fatigue of the joint.
- Night pain. 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, crunching, squeaking or clicking noises may occur.
- During an exacerbation, the periarticular area sometimes swells and turns red.
- Due to instability of the joint, the patient often twists his leg, causing sprains and tears in the ligaments.
- Stiffness and limitation of movements are noted.
Complications
During an exacerbation, reactive synovitis may occur, accompanied by the accumulation of fluid in the joint. In later stages, pronounced deformation is revealed. Movements are sharply 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 ability to work.
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 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 leading importance is given to visualization techniques:
- X-ray of the ankle joint. Plays a decisive role in making a diagnosis and determining the degree of arthrosis. 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 (located under the cartilage) zone 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 are 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 arthrosis
Treatment of the pathology 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 department of traumatology and orthopedics 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 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 medications are used:
- General NSAIDs. Usually tablet forms are used. The drugs have a negative effect on the gastric mucosa, so for gastrointestinal diseases, "gentle" medications are preferable.
- Local NSAIDs. Recommended both during the period of exacerbation and in the remission phase. May be prescribed as an alternative if side effects from tablet forms occur. 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 medications containing glucosamine and collagen hydrolysate.
- Hormonal agents. In cases of severe pain that cannot be relieved with medications, 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.
Physiotherapeutic 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 for 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 in the quality of life of patients, or limited ability to work. The operations are carried out in a hospital setting and are open and minimally invasive:
- Arthroscopic interventions. If there is significant destruction of the cartilage, arthroscopic chondroplasty is performed. Sanitation 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 articular surfaces, involves the removal of the joint and "fusion" of the bones of the foot and lower leg. Provides restoration of the supporting function of the limb in case of loss of joint mobility.
- Endoprosthetics of the ankle joint. Performed for advanced arthrosis. Involves removing the destroyed articular surfaces of bones and replacing them with plastic, ceramic or metal prostheses. Movements are restored in full, 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 the ability to work and a high quality of life for decades after the appearance of the first symptoms. With a rapid increase in pathological changes, endoprosthetics allows one to avoid disability.
Prevention
Preventive measures include reducing the level of injuries, especially in winter, during periods of ice. If you are obese, it is necessary to take measures 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 promptly treat diseases that can trigger the development of arthrosis of the ankle joint.