Osteoarthritis of the ankle joint — degenerative-dystrophic damage to cartilage tissue. But since as the disease progresses, the articular surfaces of the bones become involved in the process, it is more accurate to call it osteoarthritis. In foreign literature, when describing this disease, the term osteoarthritis is used, which indicates not only degenerative changes, but inflammation in this background.
Osteoarthritis — This is a chronic, progressive disease of the joints, in which the cartilage, articular surfaces of the bones, capsule and periarticular tissues are destroyed. This leads to pain and impaired joint mobility. The wrist rarely experiences osteoarthritis, unlike the knee. The disease occurs more often in women over 50 years old and in athletes who have suffered leg injuries. For ankle arthrosis, treatment depends on the manifestations of the disease and is selected individually by an orthopedic traumatologist. Doctors use methods that have proven their effectiveness and safety and practice a multidisciplinary approach to treating the problem and preventing the progression of joint pathology.
This article is advisory in nature. Treatment is prescribed by a specialist after consultation.
How the disease develops
The ankle joint is formed by three bones: the tibia, the fibula and the tibia, covered with an articular capsule and strengthened by ligaments. Thanks to the work of the muscles, the leg bends and stretches. Normally, the articular surfaces are smooth and easily slide relative to each other during movement. Covered with dense elastic cartilage, its main function — bone protection and load absorption. The joint cavity contains synovial fluid. It plays the role of intra-articular lubrication, preventing friction of joint elements and their erosion during movements.
But as a result of damage or natural aging of the joint, the articular surfaces become rough and the cartilage loses its softness and elasticity. When the cartilage is damaged and as the degenerative changes progress, the bones begin to come into contact with each other when they move in the joint, which is accompanied by pain.
In an effort to "protect" and compensate for further damage to the joints and surrounding tissues, osteophytes — growths along the edges of the articular surfaces of the bones — form. As a result, joint mobility is partially or even completely limited.
Depending on the root cause, the following types of osteoarthritis are distinguished:
- Primary or idiopathic osteoarthritis. In this case, it is about degenerative-dystrophic changes in the joints
- Secondary is associated with exposure to a specific causative factor, usually a previous joint injury. And this form is diagnosed more often
Predisposing factors
The main predisposing factors for the development of ankle arthrosis:
- Intra- and peri-articular injuries, such as bone fractures, ligament tears and ruptures
- ankle surgery
- inflammatory joint lesions in the past
- intense load: professional sports, ballet, long walking, work related to long periods of being "on your feet"
- sedentary lifestyle
- wearing high heels for a long time
- excess weight
- hereditary collagenopathies that lead to impaired collagen synthesis
- chronic damage to joint structures due to excessive loads
- metabolic disorders: diabetes, gout
- Estrogen deficiency in postmenopausal women
- rheumatic diseases
- foot deformities, such as flat feet
- degenerative-dystrophic changes in the spine, complicated by the formation of an intervertebral hernia, which is accompanied by compression of the nerve root.
Ankle arthrosis: symptoms
The main sign of arthrosis — Pain is what makes you seek help from a doctor. At the beginning of the development of the disease, the pain is disturbing only after prolonged exercise and decreases with rest.
Depending on the stage of pathological changes in the joint, the pain becomes more intense and continues at rest and even at night. Other symptoms appear.
There are three stages of the disease:
- The first stage is characterized by slight swelling, redness of the skin of the joint area, pain in the afternoon or after intense exercise. Unpleasant sensations are localized along the front surface of the foot, along the joint line and move to the lateral surfaces of the ankle. X-rays of the foot may not yet show any changes.
- In the second stage, the pain becomes constant, a crack appears when moving the joint, mobility is limited and the joint "locks". When examined on an X-ray, growths are observed along the edges of the articular surfaces of the bones: tibia, ankles and limbs, as well as narrowing of the joint space.
- In the third stage, the joint is deformed, which is why only oscillating, low-amplitude movements are possible. X-ray reveals massive bone growth, the joint space is significantly narrowed or even absent. Due to the instability of the joint, patients often twist their leg, which only worsens the situation due to sprains, ligament tears and deterioration of the general condition.
Pain with arthrosis of the ankle has characteristic features:
- The maximum expressed at the beginning of the movement — the so-called initial pain
- It increases significantly with the load, especially when running, jumping
- It often appears in the evening, at night or immediately after waking up
Because of the pain, there is limited mobility of the foot, as well as congestion in the joint as the cartilage is destroyed.
Symptoms appear in waves: exacerbations alternate with remissions. With an aggravation, the symptoms are more pronounced. During remission, symptoms gradually disappear and may even disappear altogether.
Which doctor should I contact?
If pain and stiffness appear in ankle movements, you should consult an orthopedic traumatologist. If another cause of joint discomfort is identified, consultation with a neurologist, rheumatologist or endocrinologist may be required.
Diagnosing
To make a diagnosis, the doctor clarifies the complaints, specifies how long the pain has been observed, which contributes to its occurrence and intensification. The specialist collects data on existing diseases, injuries and lifestyle characteristics, conducts an examination, assesses the range of motion in the joints and performs diagnostic tests.
Already based on the information received, it is possible to assume a diagnosis, but to confirm it and draw up a competent treatment plan, additional examination methods are needed, which may include:
- X-ray of the ankle joint, which is of primary importance in establishing the diagnosis and determining the stage of development of the disease. The images show narrowing of the joint space, osteophytes at the edges of the articular surfaces of the bones, cysts and signs of thinning of the bone located under the cartilage.
- A CT scan of the joint shows the picture in more detail. The doctor can assess in detail the condition of the patient's bone structures and cartilage tissue
- MRI is used to study cartilage and soft tissue
- Ultrasound of the joint to evaluate the condition of the soft structures of the joints
Treatment of arthrosis
The treatment of the pathology is long-term and is carried out under the supervision of an orthopedic traumatologist on an outpatient basis. How to cure arthrosis of the foot depends on the stage of damage and existing complications.
The main goals of treating the disease in a modern clinic are to relieve leg pain, improve the patient's quality of life and slow down the progression of arthrosis. To do this, the doctor develops a series of therapeutic and preventive measures, medicinal and non-medicinal, and also adjusts the patient's lifestyle.
Lifestyle and nutrition correction
Sufficient physical activity and correction of nutrition will help prevent degenerative changes. After the examination, the clinic's doctors can give recommendations for weight loss, as well as optimizing the load on the legs.
Drug treatment
Medicines are selected individually, based on examination data, symptoms and accompanying diseases. The patient may be prescribed:
- Analgesics. Most often these are non-steroidal anti-inflammatory drugs in the form of tablets, gels, injections to relieve pain and inflammation.
- Antidepressants and anticonvulsants for prolonged, severe, intractable pain
Exercise therapy
Specially selected exercises help maintain the range of motion in the joint, reduce pain and inhibit the progression of degenerative changes. The patient performs the recommended exercises first under the supervision of a specialist and then — by himself, at home.
Massage
Massage of the lower limbs normalizes the nutrition of joint tissues. It is described outside the acute phase. During the session, the specialist performs passive movements in the joints, which prevents shortening of the muscles and stiffness of the joints.
Auxiliary equipment
Special orthoses, canes, and walkers may be recommended to relieve stress and stabilize the ankle joint.
Surgery
It is used only in cases of severe destruction of articular cartilage and limited joint mobility. After the operation there is a long period of rehabilitation and conservative treatment. Endoprosthetics or arthroplasty in the later stages of the development of ankle arthrosis — practically the only option to avoid disability and maintain joint mobility.
Why is ankle arthrosis dangerous?
Changes already formed in the joint are irreversible. Therefore, the treatment aims to slow down the pathological process in order to maintain the ability to work and the quality of life of the patient. It is possible to achieve such goals only with timely treatment and strict adherence to the doctor's recommendations.
With the development of arthrosis, a marked deformation of the joint is formed. The range of motion is significantly reduced, as a result, the ability to support the leg becomes difficult; walking without crutches or a stick is almost impossible.
Chronic, persistent joint pain leads to anxiety and depressive disorders.
Preventing
Prevention of arthrosis includes the following measures:
- Avoid traumatic activities. For example, jumping from great heights, running
- Avoid injuries
- Be careful in icy conditions, wear non-slip shoes
- Check your body weight
- Normalizing body weight will help reduce stress on the ankle
- Stay moderately active
- An inactive lifestyle is dangerous and leads to complications, as well as overuse and microtrauma
- Keep your joints healthy
- Consult a doctor immediately and treat musculoskeletal diseases
Highlights from the article:
- The prevalence of degenerative-dystrophic diseases of the leg joints is 87%
- Occupational hazards, daily habits and past injuries can lead to ankle arthrosis.
- A common symptom of arthrosis — pain, which is accompanied by a cracking noise during movement, local swelling and later limited mobility of the leg
- Treatment of ankle arthrosis is often conservative and includes medicinal and non-medicinal methods.
- Progression of ankle arthrosis leads to disability and complete loss of foot function