Osteoarthritis of the ankle is a chronic disease that affects the articular cartilage and subsequently also other structures of the joint (capsule, synovial membrane, bones, ligaments). It has a degenerative-dystrophic character. It manifests itself in pain and restricted mobility, followed by a progressive impairment of supporting and walking functions. Diagnosis is made based on symptoms, examination and x-ray. Treatment is usually conservative and includes anti-inflammatory drugs, chondroprotectors and glucocorticoids, as well as the prescription of exercise and physiotherapy. In severe cases, sanitary arthroscopy, arthrodesis or endoprosthetics are performed.
General information
Osteoarthritis of the ankle is a disease in which the joint cartilage and surrounding tissue are gradually destroyed. The disease is based on degenerative-dystrophic processes; inflammation in 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 sharply with increasing age. At the same time, experts note that the disease is "getting younger" – one in three cases of ankle arthrosis is currently diagnosed in people under 45 years of age.
causes
Primary osteoarthritis occurs for no apparent reason. Secondary damage to the ankle joint occurs under the influence of some unfavorable factors. In both cases, the underlying cause is a violation of metabolic processes in the cartilage tissue. The main causes and predisposing factors for the development of secondary arthrosis of the ankle are:
- severe intra- and periarticular injuries (ankle fractures, ankle fractures, tears and ligament tears);
- ankle surgery;
- excessive strain: excessively intense exercise, long walking or constant standing due to working conditions;
- Wearing shoes with heels, being overweight, constant microtraumas;
- Diseases and conditions accompanied by metabolic disorders (diabetes mellitus, gout, pseudogout, estrogen deficiency in postmenopause);
- rheumatic diseases (SLE, rheumatoid arthritis);
- Osteochondrosis of the lumbar spine, intervertebral hernia and other diseases accompanied by pinched nerves and disorders of the muscles of the feet and legs.
Less commonly, nonspecific purulent arthritis, arthritis due to specific infections (tuberculosis, syphilis) and congenital developmental anomalies are the cause of arthrosis. Unfavorable environmental conditions and hereditary predisposition play a certain role in the development of osteoarthritis.
Pathogenesis
Normally, the articular 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, the cartilage loses its smoothness and becomes rough and inelastic. Cartilages "rub" during movements and injure each other, which leads to worsening pathological changes.
Due to insufficient depreciation, overload is transmitted to the underlying bone structure and degenerative-dystrophic diseases also develop: the bone is deformed and grows along the edges of the joint area. Secondary trauma and disruptions to the normal biomechanics of the joint not only affect the cartilage and bone, but also the surrounding tissue.
The joint capsule and synovial membrane thicken and foci of fibrous degeneration form in the ligaments and periarticular muscles. The joint's ability to move and withstand stress decreases. Instability occurs and the pain progresses. In severe cases, the joint surfaces are destroyed, the supporting function of the limb is impaired and movements become impossible.
Symptoms
After heavy exertion, rapid signs of fatigue and slight pain in the ankle joint are initially noticeable. Subsequently, the pain syndrome becomes more intense, the nature and time of occurrence change. Characteristic features of pain in osteoarthritis are:
- Initial pain. Appear after rest and then gradually disappear with movement.
- Dependence on the load. During physical activity (standing, walking) the pain increases and the joint quickly tires.
- Night pain. Usually appears in the morning.
The condition changes in waves, with exacerbations the symptoms are more pronounced, in the remission phase they initially disappear and then become less intense. There is a gradual progression of symptoms over several years or decades. In addition to pain, the following manifestations are noted:
- There may be crunching, squeaking or clicking noises when moving.
- During an exacerbation, the periarticular area sometimes swells and becomes red.
- Due to the instability of the joint, the patient often twists the leg, which leads to sprains and torn ligaments.
- Stiffness and restricted movement are noted.
Complications
During an exacerbation, reactive synovitis can occur, which is associated with fluid accumulation in the joint. In later stages, pronounced deformation appears. Movements are severely restricted and contractures occur. Support becomes difficult; When moving, patients have to use crutches or a cane. There is a decrease or loss of ability to work.
diagnosis
The diagnosis of arthrosis of the ankle is made by an orthopedist based on a survey, external examination data and the results of other studies. During the initial examination, there may be no changes, but later deformities, limitation of movement, and pain on palpation become apparent. The visualization techniques are given outstanding importance:
- X-ray of the ankle joint. Plays a crucial role in making a diagnosis and determining the degree of osteoarthritis. The pathology is indicated by a narrowing of the joint space and 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 noted.
- Tomographic studies. Used when specified. In difficult cases, for a more accurate assessment of the condition of the bone structures, the patient is sent, in addition to a computed tomography, and for the examination of soft tissues - to an MRI of the ankle joint.
The laboratory tests remain unchanged. If necessary, consultations with related specialists are prescribed to determine the cause of arthrosis and differential diagnosis with other diseases: neurologist, rheumatologist, endocrinologist.
Treatment of ankle osteoarthritis
Treatment of pathology is long-term and complex. Patients are usually examined by an orthopedist on an outpatient basis. During the exacerbation period, hospitalization in the department of traumatology and orthopedics is possible. The most important role in slowing the progression of osteoarthritis is played by lifestyle and the right type of physical activity. Therefore, the patient is given recommendations for losing weight and optimizing leg loading.
Drug therapy
The selection is made individually, taking into account the stage of osteoarthritis, the severity of the symptoms and concomitant illnesses. Includes general and local agents. The following drug groups are used:
- General NSAIDs. Tablet forms are usually used. The medications have a negative effect on the gastric mucosa, so "gentle" medications are preferable for gastrointestinal diseases.
- Local NSAIDs. Recommended both during the exacerbation phase and in the remission phase. May be prescribed alternatively if side effects occur from tablet forms. Available in the form of ointments and gels.
- Chondroprotectors. Substances that contribute to the normalization of 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 hydrolyzate.
- Hormonal active ingredients. For severe pain that cannot be relieved with medication, intra-articular corticosteroids are administered a maximum of four 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 physiotherapy, which is developed taking into account the manifestations and stage of the disease. The patient is referred for physical therapy. In the treatment of arthrosis, massage and UHF are used. In addition, in the treatment of pathologies they use:
- laser therapy;
- thermal processes;
- medical electrophoresis and ultraphonophoresis.
surgery
Indicated in the later stages of the disease, when conservative therapy is ineffective, severe pain syndrome occurs, the quality of life of patients worsens or the ability to work is limited. The operations are performed in a hospital environment and are open and minimally invasive:
- Arthroscopic procedures. If there is significant destruction of the cartilage, arthroscopic chondroplasty is performed. If there is severe pain in stage 2 of osteoarthritis, remedial arthroscopy (removal of formations that inhibit movement) is usually carried out. The effect lasts for several years.
- Arthrodesis of the ankle joint. It is carried out in cases of significant destruction of the articular surfaces and involves the removal of the joint and the "fusion" of the bones of the foot and lower leg. Provides the restoration of the supporting function of the limb in the event of loss of joint mobility.
- Endoprosthetics of the ankle joint. Performed for advanced osteoarthritis. The destroyed joint surfaces of the bones are removed and replaced with plastic, ceramic or metal prostheses. Movements are completely restored, the service life of the prosthesis is 20-25 years.
forecast
Joint changes are irreversible, but the slow progression of arthrosis, the timely start of treatment and adherence to 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 makes it possible to avoid disability.
prevention
Preventative measures include reducing the frequency of injuries, especially in winter during periods of ice. If you are overweight, measures to reduce body weight must be taken to reduce the load on the joint. You should adhere to moderate physical activity, avoid overloads and microtraumas, and timely treat diseases that can trigger the development of ankle arthrosis.