Osteoarthritis of the ankle joint is a chronic disease that affects the articular cartilage and then other joint structures (capsule, synovium, bones, ligaments). It has a degenerative-dystrophic character. It presents as pain and limitation of movements, followed by progressive impairment of support and walking functions. The diagnosis is made on the basis of 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
Osteoarthritis 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 gradually progresses. Women and men suffer equally often. The possibility of development increases significantly 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 old.
Causes
Primary arthrosis occurs for no apparent reason. Secondary ankle damage develops under the influence of several 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 ankle arthrosis are:
- major intra- and peri-articular injuries (tail fractures, ankle fractures, lacerations and ruptures of ligaments);
- ankle surgery;
- excessive load: very intense sports, long walks or constant standing due to working conditions;
- wearing shoes with heels, excess weight, constant microtrauma;
- diseases and conditions related to 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 compression of nerves and disruption of the muscular system of the leg and foot.
Less often, the cause of arthrosis is non-specific purulent arthritis, arthritis due to specific infections (tuberculosis, syphilis) and congenital anomalies of development. Adverse 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, the cartilage loses its softness, becomes tough and inelastic. Cartilage "rubs" during movements and damages each other, which leads to the worsening of pathological changes.
Due to insufficient damping, 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 articular area. Due to the secondary trauma and disruption of the normal biomechanics of the joint, not only the cartilage and bone, but also the surrounding tissues suffer.
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 movement and withstand loads is reduced. Instability appears and pain progresses. In severe cases, the articular surfaces are destroyed, the supporting function of the limbs is damaged and movements become impossible.
Symptoms
Initially, rapid fatigue and slight pain in the ankle are detected after a significant load. Then, the pain syndrome becomes more intense, its nature and time of occurrence change. Distinctive features of arthrosis pain are:
- The onset of pain. Appears after a state of rest, and then gradually disappears with movement.
- Load dependence. There is increased pain during exercise (standing, walking) and rapid joint fatigue.
- Night pain. They usually appear in the morning.
The condition changes in waves, during exacerbations the symptoms are more pronounced, in the phase of remission they first disappear, then they become less intense. There is a gradual progression of symptoms over several years or decades. Along with pain, the following manifestations are determined:
- When you move, there may be popping, creaking, or clicking noises.
- During an irritation, the periarticular area sometimes swells and becomes red.
- Due to the instability of the joint, the patient often twists the leg, causing sprains and tears in the ligaments.
- Stiffness and limitation of movements are noted.
Complications
During an exacerbation, reactive synovitis may appear, accompanied by the accumulation of fluid in the joint. In the later stages, pronounced deformation is detected. Movements are very 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 the ability to work.
Diagnosing
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 deformities, limitations of movements and pain on palpation are revealed. The main importance is given to visualization techniques:
- X-ray of the ankle. It plays a decisive role in establishing the diagnosis and determining the degree of arthrosis. The pathology is indicated by the narrowing of the articular space, the proliferation of the edges of the articular 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 also sent to a computed tomography scan, and to examine the soft tissues - to an MRI of the ankle.
Laboratory tests are unchanged. If necessary, to determine the cause of arthrosis and differential diagnosis with other diseases, consultations with related specialists are prescribed: neurologist, rheumatologist, endocrinologist.
Treatment of ankle arthrosis
The 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 deterioration, hospitalization in the department of traumatology and orthopedics is possible. The most important role in slowing down the progression of arthrosis is played by the way of life and the right way of physical activity, therefore the patient is given recommendations for weight loss and optimization of the load on the legs.
Drug therapy
It is selected individually, taking into account the stage of arthrosis, severity of symptoms and associated diseases. Includes general and local agents. The following groups of drugs are used:
- Generic NSAIDs. Tablet forms are usually used. Medicines have a negative effect on the stomach mucosa, so "soft" medicines are preferred for gastrointestinal diseases.
- Topical NSAIDs. It is recommended both during the period of irritation and in the phase of remission. It can be prescribed as an alternative if side effects occur from tablet forms. 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 hydrolysis.
- Hormonal agents. In cases of severe pain that is not relieved by medication, 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 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
It is indicated in the later stages of the disease when conservative therapy is ineffective, severe pain syndrome, worsening of patients' quality of life or limited ability to work. 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. Hygienic 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 performed in the event of significant destruction of the articular surfaces, involves removing the joint and "joining" the bones of the foot and lower leg. It ensures the restoration of the supporting function of the limbs in case of loss of joint mobility.
- Endoprosthetics of the ankle joint. It is performed for advanced arthrosis. It involves removing the destroyed articular surfaces of the bones and replacing them with plastic, ceramic or metal prostheses. The movements are completely restored, the service life of the prosthesis is 20-25 years.
prediction
Changes in the joints are irreversible, but the slow progress of arthrosis, the timely start 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 onset. from the first symptoms. With a rapid increase in pathological changes, endoprosthetics allows a person to avoid disability.
Preventing
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 joints. You should maintain a moderate physical activity regime, avoid overloads and microtraumas and immediately treat diseases that can cause the development of ankle arthrosis.