Arthrosis of the ankle joint — degenerative-dystrophic damage to the cartilage tissue. But since the joint surfaces of the bones are involved in the process as the disease progresses, 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 the background.
Osteoarthritis — This is a chronic, progressive joint disease in which cartilage, articular surfaces of bones, capsule and periarticular tissues are destroyed. This leads to pain and impaired joint mobility. Ankles rarely experience osteoarthritis, unlike knees. The disease occurs more often in women over 50 years of age and in athletes who have suffered foot injuries. In arthrosis of the ankle joint, the treatment depends on the manifestations of the disease and is selected individually by the orthopedic traumatologist. Doctors use methods that have proven their effectiveness and safety, and use a multidisciplinary approach to treat the problem and prevent the progression of joint pathology.
This article is informative. The treatment is prescribed by a specialist after consultation.
How the disease develops
The ankle joint is made up of three bones: the tibia, fibula and talus, which are covered by a joint capsule and strengthened by ligaments. Thanks to the work of the muscles, the leg bends and stretches. Normally, the articular surfaces are smooth and slide easily relative to each other during movement. Covered by dense, flexible cartilage, its main function is bone protection and load absorption. The joint cavity contains synovial fluid. It plays the role of lubrication within the joint, preventing friction and wear of joint elements during movement.
But due to injury or natural aging of the joint, the joint surfaces become rough and the cartilage tissue loses its smoothness and elasticity. When the cartilage is damaged and the degenerative changes progress, the bones begin to come into contact with each other during joint movement, which causes pain.
In an attempt to "defend" and to compensate for further damage to the joint and surrounding tissues, osteophytes are formed — growths along the edges of the joint surface of the bones. As a result, the mobility of the joint is partially or even completely limited.
Depending on the underlying cause, the following types of osteoarthritis are distinguished:
- Primary or idiopathic osteoarthritis. In this case, we are talking about degenerative-dystrophic changes in the joint
- Secondary is related to exposure to a specific causative factor, usually a previous joint injury. And this form is most often diagnosed
Predisposing factors
The main predisposing factors for the development of arthrosis of the ankle joint:
- intra- and peri-articular injuries such as bone fractures, lacerations and ligament tears
- ankle surgery
- inflammatory joint changes in the past
- intensive loads: professional sports, ballet, long walks, work with long "standing" periods
- sedentary lifestyle
- she wore high heels for a long time
- overweight
- hereditary collagenopathies that lead to impairment of collagen synthesis
- chronic injuries of 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, accompanied by compression of the nerve root
Ankle arthrosis: symptoms
The main sign of arthrosis — Pain is what calls for a doctor's visit. At the beginning of the development of the disease, the pain is bothersome only after prolonged exertion, 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 appear.
The disease has three stages:
- The first stage is characterized by slight swelling, redness of the joint area, pain in the afternoon or after intense training. Unpleasant sensations are localized along the front surface of the foot, along the line of the joint, and move to the lateral surfaces of the ankle. X-rays of the feet may not yet show any changes.
- In the second stage, the pain becomes constant, a crack appears when the joint is moved, mobility is limited, and the joint "gets stuck". X-rays show growths on the edges of the articular surface of the bones: tibia, ankle and foot, as well as a narrowing of the joint space.
- In the third stage, the joint is deformed, so only rocking, low-amplitude movements are possible. The X-ray reveals massive bone growths, the joint space is sharply narrowed or absent. Due to the instability of the joint, patients often twist their legs, which only aggravates the situation due to sprains, ligament tears and deterioration of the general condition.
The pain associated with arthrosis of the ankle has characteristic features:
- The maximum expressed at the beginning of the movement — so-called starting pain
- It increases significantly with load, especially when running and jumping
- It often appears in the evening, at night, or right after waking up
Due to the pain, the movement of the leg is limited and the joint gets stuck as the cartilage is destroyed.
The symptoms manifest themselves in waves: exacerbations alternate with remissions. In case of worsening, the symptoms are more pronounced. During remission, the symptoms gradually ease and may even disappear completely.
Which doctor should I see?
If there is pain and stiffness in the movement of the ankle, 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, determines 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, performs an examination, assesses joint range of motion and carries out diagnostic tests.
Already based on the information received, the diagnosis can be assumed, but in order to confirm it and prepare the appropriate treatment plan, additional examination methods are required, which may include:
- An X-ray of the ankle joint, which is of primary importance in establishing a diagnosis and determining the stage of the disease's development. The images show the narrowing of the joint space, osteophytes, cysts on the edges of the joint surface of the bones, and signs of osteoporosis located under the cartilage.
- A CT scan of the joint reflects the picture in more detail. The doctor can assess the condition of the patient's bone structure and cartilage tissue in detail
- MRI is used to study cartilage and soft tissues
- Ultrasound of the joint to assess the condition of the soft joint structures
Treatment of arthrosis
The pathology is treated on a long-term basis under the supervision of an outpatient orthopedic traumatologist. Treatment of foot arthrosis depends on the stage of damage and existing complications.
The main goal of treating the disease in a modern clinic is to relieve leg pain, improve the patient's quality of life and slow down the progression of arthrosis. For this, the doctor develops therapeutic and preventive measures, medical and non-medical goals, and modifies the patient's lifestyle.
Lifestyle and nutrition correction
Adequate physical activity and nutritional correction help curb degenerative changes. After the examination, the clinic's doctors can make recommendations for weight loss and optimizing the load on the legs.
Drug treatment
Medicines are selected individually, based on test data, symptoms and accompanying diseases. The patient may be prescribed:
- Pain relievers. 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 long-lasting, severe, difficult-to-treat pain
Exercise therapy
Specially selected exercises help to maintain joint range of motion, reduce pain and stop the progression of degenerative changes. The patient first performs the recommended exercises under the supervision of a specialist, and then — alone, at home.
Massage
Massage of the lower limb normalizes the nutrition of joint tissues. It is prescribed outside the acute stage. During the session, the specialist performs passive movements in the joint, which prevents muscle shortening and joint stiffness.
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 damage to the articular cartilage and limited joint mobility. After the operation, there is a long rehabilitation period and conservative treatment. Endoprosthesis 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 that have already developed in the joint are irreversible. Therefore, the goal of treatment is to slow down the pathological process in order to preserve the patient's ability to work and quality of life. These goals can only be achieved with timely treatment and strict adherence to the doctor's recommendations.
With the development of arthrosis, a pronounced deformation of the joint is formed. The range of motion is sharply reduced, as a result of which the ability to hold the feet becomes difficult, walking without crutches or a cane is almost impossible.
Chronic, persistent joint pain leads to anxiety and depressive disorders.
Prevention
Prevention of arthrosis includes the following measures:
- Avoid traumatic activities. For example, jumping from a great height, running
- Avoid injury
- Be careful in icy conditions, wear non-slip shoes
- Control your weight
- Normalizing body weight helps reduce stress on the ankle joint
- Stay moderately active
- An inactive lifestyle is dangerous and leads to complications, overuse and microtrauma
- Keep your joints healthy
- See a doctor immediately and treat musculoskeletal disorders
The main points of the article:
- The prevalence of degenerative-dystrophic diseases of the leg joints is 87%
- Occupational hazards, everyday habits and past injuries can lead to arthrosis of the ankle joint.
- A common symptom of arthrosis is pain accompanied by a creaking sound during movement, local swelling, and later limited movement of the leg
- Treatment of ankle arthrosis is often conservative and includes both drug and non-drug methods.
- Progression of ankle arthrosis leads to disability and complete loss of leg function