Arthrosis of the ankle joint: degenerative-dystrophic damage to the cartilaginous tissue. But since as the disease progresses, the articular surfaces of the bones are involved in the process, it is more correct to call it osteoarthritis. In foreign literature, when describing this disease, the term osteoarthritis is used, which indicates not only degenerative changes, but also inflammation in this context.
Osteoarthritis: This is a chronic and progressive joint disease in which the cartilage, articular surfaces of the bones, capsule and periarticular tissues are destroyed. This leads to pain and reduced joint mobility. The ankle rarely suffers from osteoarthritis, unlike the knee. The disease occurs more often in women over the age of 50 and in athletes who have suffered foot injuries. For arthrosis of the ankle joint, 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 treat the problem and prevent 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 made up of three bones: tibia, fibula and talus, covered by a joint capsule and strengthened by ligaments. Thanks to the work of the muscles, the foot bends and extends. Normally, the joint surfaces are smooth and slide easily relative to each other during movements. Covered with dense and 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 the joint elements and their abrasion during movements.
But due to injury or natural aging of the joint, the joint surfaces become rough and the cartilage tissue loses its softness and elasticity. When the cartilage is damaged and as degenerative changes progress, the bones begin to come into contact with each other during joint movement, which is accompanied by pain.
In an attempt to "defend" themselves and to compensate for further damage to the joint and surrounding tissues, osteophytes are formed - growth along the edges of the articular surfaces of the bones. As a result, the mobility of the joint is partially or even completely limited.
Depending on the main cause, the following types of arthrosis are distinguished:
- Primary or idiopathic osteoarthritis. In this case we are talking about degenerative-dystrophic alterations of the joint
- Secondary is associated with exposure to a specific causative factor, usually a previous joint injury. And this form is often diagnosed
Predisposing factors
The main predisposing factors for the development of arthrosis of the ankle joint:
- intra- and periarticular injuries, such as bone fractures, strains and ligament ruptures
- ankle surgery
- inflammatory joint lesions in the past
- intense loads: professional sports, classical dance, long walks, work associated with long periods of "standing"
- sedentary lifestyle
- wear high heels for a long time
- excess weight
- hereditary collagenopathies that lead to impaired collagen synthesis
- chronic injuries 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 arthritis: symptoms
The main sign of osteoarthritis — Pain is what makes you seek help from a doctor. At the beginning of the development of the disease, the pain is bothersome only after prolonged exercise and decreases with rest.
Depending on the stage of pathological changes in the joint, the pain becomes more intense and persists at rest and even at night. Other symptoms occur.
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 strenuous 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. The x-ray of the foot may not yet show any changes.
- In the second stage, the pain becomes constant, a crunch occurs when moving the joint, mobility is limited, and the joint "jams". When examined on an x-ray, growths are noted along the edges of the articular surfaces of the bones: tibia, ankles and talus, as well as narrowing of the joint space
- In the third phase the joint deforms, which is why only small-amplitude oscillating movements are possible. The x-ray reveals massive bone growths, the joint space is markedly reduced or even absent. Due to the instability of the joint, patients often twist their leg, which only aggravates the situation due to sprains, torn ligaments and deterioration of the general condition
Pain with arthrosis of the ankle has characteristic features:
- Maximum expressed at the beginning of the movement: — the so-called initial pain
- It increases significantly with load, especially when running, jumping
- It often appears in the evening, at night or immediately after waking up
Due to pain, the mobility of the foot is limited and the joint becomes blocked due to destruction of the cartilage.
Symptoms occur in waves: exacerbations alternate with remissions. With a flare-up, the symptoms are more pronounced. During remission, symptoms gradually remit and may even disappear completely.
Which doctor should I contact?
If you experience pain and stiffness when moving your ankle, you should consult an orthopedic traumatologist. If another cause of joint discomfort is identified, consultation with a neurologist, rheumatologist, or endocrinologist may be necessary.
Diagnostics
To make a diagnosis, the doctor clarifies the complaints, specifies how long the pain has been observed, which contributes to its appearance and intensification. The specialist collects data on existing diseases, injuries and lifestyle characteristics, conducts an examination, evaluates the range of motion of the joint and performs diagnostic tests.
Already on the basis of 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 making a 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 reflects the image in more detail. The doctor can evaluate in detail the state of the patient's bone structures and cartilaginous tissue
- MRI is used to study cartilage and soft tissue
- Ultrasound of the joint to evaluate the condition of the soft joint structures
Treatment of osteoarthritis
Treatment of the pathology is long-term and is carried out under the supervision of an orthopedic traumatologist on an outpatient basis. How to treat arthrosis of the leg 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 the progression of arthrosis. To do this, the doctor develops a set of therapeutic and preventive measures, medicinal and non-medicinal, and also adapts the patient's lifestyle.
Correction of lifestyle and nutrition
Sufficient physical activity and nutritional correction will help slow degenerative changes. After the examination, doctors at the clinic can give advice on weight loss and optimizing the load on the legs.
Pharmacological treatment
Drugs are selected individually, based on examination data, symptoms and concomitant 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, and difficult-to-treat pain
Physical therapy
Specially selected exercises help maintain the joint's range of motion, reduce pain and slow the progression of degenerative changes. The patient first performs the recommended exercises under the supervision of a specialist, then — alone, at home.
Massage
Massage of the lower limb normalizes the nutrition of the joint tissues. It is prescribed outside the acute phase. During the session the specialist performs passive movements of the joint, which prevent muscle shortening and joint stiffness.
Assistive devices
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, a long period of rehabilitation and conservative treatment is expected. Endoprosthesis or arthroplasty in the later stages of development of ankle arthrosis: practically the only opportunity to avoid disability and maintain joint mobility.
Why is ankle arthritis dangerous?
Already formed changes in the joint are irreversible. Therefore, treatment aims to slow down the pathological process in order to preserve the patient's working capacity and quality of life. It is possible to achieve such goals only with timely treatment and strict adherence to the doctor's recommendations.
As arthrosis develops, a pronounced deformation of the joint is formed. The range of motion decreases dramatically, consequently the ability to support the foot becomes difficult; walking without crutches or a cane is almost impossible.
Chronic and constant joint pain leads to anxiety and depressive disorders.
Prevention
Prevention of arthrosis includes the following measures:
- Avoid traumatic activities. For example, jumping from great heights, running
- Avoid injury
- Be careful in icy conditions and wear non-slip shoes
- Check your body weight
- Normalization of body weight will help reduce stress on the ankle joint
- Stay moderately active
- An inactive lifestyle is dangerous and leads to complications, as well as excessive overload and microtraumas
- Keep your joints healthy
- Timely consult a doctor and treat musculoskeletal diseases
Main points of the article:
- The prevalence of degenerative-dystrophic diseases of the foot joints is 87%
- Occupational risks, daily habits and past injuries can lead to osteoarthritis of the ankle joint.
- A common symptom of arthrosis: pain, which is accompanied by a crunch during movement, local swelling and subsequently limited mobility of the foot
- Treatment of ankle arthritis is often conservative and includes both medicinal and non-medicinal methods.
- The progression of ankle arthritis leads to disability and complete loss of foot function