In recent years, experts around the world have noted an increase in degenerative-dystrophic processes in the ankle, which is gradually leading to disability. Arthritis of the ankle joint often develops as a result of serious injuries or constant microtrauma in athletes, professional dancers, circus performers. You will learn in this article how to notice the signs of this disease in time and stop its progression, as well as how to treat it.
Ankle Osteoarthritis - What is it?
The ankle is a complex block-like joint formed by the lower (distal) ends of the shin and the fibers of the lower leg, forming the internal and external ankles (ankles), as well as the talus of the foot. It is reinforced internally by the deltoid ligament, externally by the anterior and posterior talofibular and calcaneofibular ligaments. Function: leg flexion and extension. The ankle is functionally connected to the foot, has common ligaments and muscle tendons to the foot joints.
Osteoarthritis of the ankle joint is a degenerative-dystrophic disease that begins with thinning and destruction of the articular cartilage, reducing its amortization properties, followed by the involvement of all other joint tissues in the pathological process. The disease gradually leads to complete wear and tear of the joint and disability. The ankle joint arthrosis code ICD-10 is M19.
The disease is less common than knee-like injuries and is usually the result of serious injury or prolonged injury as a result of any activity.
Causes of ankle osteoarthritis
Specialists have studied in detail the causes of the development of arthrosis of the ankle joint and osteoarthritis of the foot. this:
- Injuries - intra-articular fractures of the joints, fractures of the ankles, complete and incomplete fractures of ligaments and tendons;
- Microtrauma for any professional activity - these are ballerinas, dancers, professional athletes;
- Increased load on the legs during excess body weight;
- Improper distribution of load when wearing high-heeled shoes;
- Metabolic disorders that adversely affect cartilage metabolism - diabetes mellitus, obesity, gout, etc. Sh.
- Hormonal changes, including age-related;
- Transferred to severe acute purulent arthritis;
- Prolonged chronic arthritis of any origin;
- Osteochondrosis of the lumbar spine and intervertebral hernia, which causes disruption of the spinal roots and weakening of the muscles of the lower leg and foot, leading to instability of the joints and injuries.
Mechanism of disease development (pathogenesis)
Under the influence of various causes, the blood circulation in the joint area is disrupted, leading to a reduction in the volume of synovial fluid that nourishes the cartilage tissue. Due to the lack of oxygen and nutrients, the cartilage thins, cracks and erodes. This causes damage to the subcartilaginous layer of bone. Thickens (scleroses) and grows on the edges of articular surfaces. These formations are called osteophytes. They suffocate the soft tissues, blood vessels and nerves, causing pain and subsequently disrupting blood circulation.
Due to circulatory disorders and high tension, the muscles suffer, weaken, leading to joint instability and frequent dislocation. Arthrosis of the foot develops, small tarsal joints, metatarsal-tarsal, metatarsophalangeal and interphalangeal joints are damaged.
Gradually, connective tissue grows in the joints, which tightly connects to the joint surfaces and disrupts the function of the joint. Complete loss of ankle function is associated with fusion of the articular joints of the bone. Gradually arthrosis of the foot also develops.
Symptoms of ankle osteoarthritis
Ankle osteoarthritis initially progresses slowly and unnoticed. But the symptoms gradually appear and increase, indicating some kind of disorder in the lower extremity.
The first signs
The very first symptom of osteoarthritis of the ankle is pain during high activity, for example, during long walks, dancing, playing football or volleyball, etc. Sh. This pain passes quickly, so the person does not immediately pay attention to it, giving it muscle fatigue. Pain can be both symmetrical in both joints (with high loads and microtraumas) as well as unilateral (after large trauma).
Then in the morning or after a long stay in a sedentary state, firmness appears. The ankles tighten for a while, making movement difficult. In the initial stages it lasts a few minutes and passes at a slow pace. This symptom should already be alerted and become a reason to see a doctor.
Obvious symptoms
Gradually, the pain intensifies after exercise and lasts longer. The leg may ache throughout the day. Night pains join, they usually appear in the second half of the night and are sometimes accompanied by painful muscle cramps. Periods of stiffness after immobility are also prolonged.
Because of the severe pain, the person begins to limp while walking, trying to reduce leg pain by stretching or pressing. Sometimes the ankle is swollen, the skin on it becomes red, the pain intensifies. This is a sign of synovitis - inflammation of the inner synovial membrane. Inflammation is non-infectious in nature, develops from mechanical irritation, and disappears on its own without treatment. But at the same time, the exacerbation of synovitis activates the progression of the joint degenerative-dystrophic process.
Dangerous symptoms
Persistent excruciating pain, aggravated by physical exertion, instability, joint loosening, prone to subluxation, dislocation, and ligament injuries are dangerous symptoms that require a visit to the physician. The ankle changes appearance: it takes on a different shape due to excessive osteophytes. Osteoarthritis of the ankle (ankle) causes it to thicken. The movement of the foot is initially slightly restricted, and then the ankle becomes motionless or, conversely, loose, unstable. But even at this point you can help the patient, you just need to contact the clinic. Symptoms of osteoarthritis of the foot: pain in the foot, impaired flexibility and impairment. The development of osteoarthritis of the big toe is accompanied by pain and deformity in the form of bulging and bending of the outside of the big toe.
What is dangerous ankle osteoarthritis
The danger is that the disease develops unnoticed from the beginning and very often the patient goes to the doctor at an already advanced stage.
Any localization and form of osteoarthritis has serious complications, so treatment should not be delayed.
Classification
Osteoarthritis of the ankle can be primary when the cause of its development has not been established and secondary, with a known cause of origin. Depending on the cause of development, the disease may have its own distinctive features.
Posttraumatic arthrosis of the ankle joint
Consequences of traumatic injury are the most common cause of disease. Posttraumatic arthrosis of the ankle joint can develop after a major injury - ligament rupture, dislocation, intra-articular fracture. Usually one joint is injured, so posttraumatic arthrosis is unilateral. A small but incurable injury may not be felt from the beginning. And only after a certain period, when the person has already forgotten about it, does a slightly increasing pain appear. This type of injury is dangerous because the patient goes to the doctor in an already abandoned condition. Serious injuries are better treated, their consequences appear faster and the patient seeks medical help not too late.
Unnoticed long microtrauma to both ankles is typical of professional dancers, athletes, and people whose profession is associated with long standing. Symmetrical pain in the ankles occurs during physical activity. They are usually mistaken for muscle soreness with fatigue, so it is too late to see a doctor.
Ankle osteoarthritis after arthritis
Causes of this arthrosis can be chronic inflammatory processes of the joints (arthritis): rheumatoid, reactive, psoriatic. In this case the inflammatory processes are combined with degenerative-dystrophic (arthritis-arthritis). This speeds up the ankle destruction process. With exacerbation of inflammation, swelling of the joints, the skin on them becomes red, the pain becomes very strong, especially at night. When inflammation subsides, metabolic disorders predominate, and all processes develop very rapidly. The disease requires constant monitoring and treatment by a rheumatologist.
More rarely, the degenerative-dystrophic process develops after acute purulent arthritis. The purulent process destroys the articular tissues and after recovery, connective tissue is formed in their place, which disrupts the function of the limb.
Osteoarthritis can also develop after infectious arthritis - tuberculosis, gonorrhea, etc. Sh. Disease progression is related to the underlying infectious process and the nature of the destruction. If the infection persists, the destruction of the joints progresses.
Metabolic
Develops with a long course of gout. Very often the first finger is injured. Other small joints of the foot and ankle are less frequently injured. As gout attacks persist, it is externally difficult to determine when a degenerative-dystrophic process occurs. You can only see it on an X-ray. In any case, the patient should be regularly monitored by a rheumatologist and examined periodically.
Deformable arthrosis of the ankle joint
All types of arthrosis become deformed over time. Bone deformity indicates an advanced stage of the disease when the cartilage has already disintegrated and the constant mechanical impact on the bone tissue promotes its growth along the edges of the articular surface. This is how osteophytes are formed, which change the shape of the joint.
Degree of ankle joint arthrosis
There are several classifications, one of which distinguishes three clinical and radiological stages of arthrosis:
- Early. Minor pain after standing or walking for a long time, firmness in the morning. It all disappears quickly without any help. X-ray: Normal or slight narrowing of the joint space.
- Progressive. The pain is stronger and longer after physical activity. As stiffness increases, cramps in the joints occur during movement. Sometimes the joint is swollen, red and very painful - a sign of synovitis. X-ray shows significant narrowing of the joint space, thickening of the cartilaginous bone tissue (osteosclerosis) and proliferation of osteophytes.
- Final. The pain syndrome intensifies, becoming permanent. Because of the pain a person limps, lifts his legs, uses a cane or crutches. Impaired limb function, develops arthrosis of the leg and thumb. Complete absence of flexion-extensor movements is rare, usually on the background of arthrosis-arthritis. On X-ray: no joint space, osteosclerosis, large osteophytes deform the joint.
Possible complications
If the disease is not treated and everything takes its course, then the following complications are possible:
- Persistent joint dysfunction and disability;
- Severe persistent pain in the ankles and feet, both after and without exercise;
- Ankle instability with the development of the usual dislocations and subluxations;
- Injuries to the foot and thumb will join, which will further aggravate the patient's condition.
Diagnosis of ankle arthrosis
Before prescribing treatment, the doctor examines the patient, including:
- Medical interviews and examinations;
- Additional research methods: laboratory tests (signs of inflammation and metabolic disorders detected), instrumental studies (joint radiography in two projections, computed tomography and magnetic resonance imaging - early changes in bone structures and soft tissues), diagnostic arthroscopy (internal).
Treatment of osteoarthritis of the ankle joint
After making a final diagnosis, the doctor selects the patient's individual treatment complex, which consists of medical and non-narcotic methods.
Medical treatment of osteoarthritis of the ankle joint
Medications are prescribed that are symptomatic (reduce disease symptoms) and pathogenetic (inhibit the mechanism of disease development).
Anti-inflammatory and analgesic
To relieve pain, drugs from the group of nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed in short courses, they relieve pain and inflammation well (if synovitis has worsened):
- Injection;
- Rectal suppositories;
- Oral tablets;
- Skin patch.
Muscle relaxants
The muscles surrounding the diseased joint and performing its movement are in constant tension, causing them to atrophy and intensifying pain. Medications from the group of muscle relaxants are prescribed to eliminate muscle spasms.
Chondroprotectors
Medications in the chondroprotective group contain glucosamine or chondroitin, and sometimes both of these substances. They protect cartilage cells from destruction and help them recover. They are prescribed in the form of injections, tablets and external agents (creams and ointments).
Hyaluronic acid preparations for ankle joint osteoarthritis
To improve the cushioning capacity of the synovial fluid and to prevent further damage to the cartilage and bone tissues, hyaluronic acid is injected into the joint cavity. This leads to pain relief and improved joint mobility.
Anti-arthritic gels and ointments for arthrosis of the ankle joint
External means can be used at home. Ointments for ankle arthrosis:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are suitable for relieving pain and inflammation;
- To restore cartilage - gel and ointment based on chondroitin.
Non-drug therapy
The main methods of treatment of osteoarthritis of the ankle are non-narcotic. These are therapeutic exercises, massage, physiotherapy, wearing orthopedic devices.
Physiotherapy
To alleviate the patient's condition and restore joint function, appoint:
- Electrophoresis with healing substances;
- Laser therapy;
- Magnetotherapy;
- Warming procedures - paraffin, ozocerite, in resort conditions - use of mud.
Massage during osteoarthritis of the ankle joint
Massage courses improve blood circulation, which leads to the activation of metabolism, the restoration of joint and extracellular tissues. The positive effect of massage on the muscles is to eliminate spasms, which promotes blood flow to the muscles and restores their strength, which is necessary to hold the limb in the desired position.
Exercises and Exercise Therapy for Ankle Osteoarthritis
Therapeutic gymnastics is a panacea for arthrosis. Motor activity is very important, in addition to exercise therapy swimming is useful. Systematic implementation of exercises selected by your doctor allows you to greatly restore limb function, even in the case of advanced disease.
Probable set of exercises (but before you start doing it, you need to consult a doctor):
Use of special orthopedic products
To prevent the progression of the disease, your doctor may prescribe a special orthopedic device - an orthosis. Fixes the foot in the correct anatomical position, relieves muscle tension, improves blood circulation. Wearing an orthosis is prescribed by a doctor who also chooses the most suitable model.
Ankle fixation can also be done using tape: with special adhesive tapes the ankle is gently fixed in the desired position.
surgery
Surgery is recommended for severe pain that is not eliminated by conservative methods of treatment, as well as for significant limb dysfunction.
Types of surgical intervention
Operations can be performed in traditional and gentle ways:
- Therapeutic arthroscopy (saved operations):
- Articular cavity sanitation - with the help of an arthroscope, fragments of cartilage and bone tissue are removed from the cavity, which impedes movement and causes pain;
- Chondroplasty - removal of the damaged layer of cartilage, which stimulates the growth of new cartilage cells (abrasive chondroplasty); In some cases, autocartillary sections are taken from loaded areas of the patient's knee joint (mosaic arthroplasty); Chondroplasty is effective in stage 2 disease when the joint has not yet lost function.
- Arthrodesis is a traditional surgical operation. Is carried out with significant impairment of limb function, its loosening, the usual dislocations and pain. The joint is removed, the lower leg bones merging with the leg bones. The ankle becomes immobile and only serves as a support.
- Endoprosthesis is an artificial replacement of a worn and lost function of the ankle.
Peculiarities of postoperative rehabilitation
All surgeries are performed in an inpatient setting, after which experts recommend a complete rehabilitation. With moderate surgery, rehabilitation is performed on an outpatient basis, with early inclusion in a course of therapeutic exercise, in addition to a high load on the joint. After the endoprosthesis, the patient stays in the hospital for a week, after which rehabilitation measures are performed on an outpatient basis. After two weeks, the suture is removed and the patient can take a shower.
Dietary foods
There is no special diet for osteoarthritis. But to eliminate unnecessary stress on the ankle it is necessary to maintain a normal body weight. A person should get a proper healthy diet, but the amount of high-calorie food should be partially replaced by vegetables and fruits. Useful low-fat first and second courses, chicken, sea fish, cottage cheese, cheese, dairy products.
Traditional medicine
Using traditional medicine alone will not help with osteoarthritis. But they can be used as part of a complex treatment prescribed by a doctor. Here are some recipes:
- For oral administration: infusion of wild rosemary; 20 g of finely chopped herb pour 500 ml of boiling water in a thermos at night, strain in the morning and take half a cup 4 times a day for a month; Analgesic, cartilage tissue repair;
- For oral administration: Take a ball of mummy 0, 5 cm in diameter in the morning, chew well, 30 minutes before eating for 10 days; Break for 5 days, then repeat everything 3 more times; An excellent stimulator of metabolic processes;
- Honey massage: Before going to bed, apply warm liquid honey on the ankle and gently massage with a tissue massage for 5 minutes; Then wrap the leg in a warm shawl and leave until morning; Restores blood circulation and metabolism in cartilage tissue.
Approach to treatment in clinics
The doctors of the clinic have developed their own approach to treating diseases such as arthrosis of the ankle and foot. At the initial appointment, a thorough examination of the patient is performed, the doctor carefully listens to his complaints and medical history, after which he appoints additional laboratory and instrumental examinations, including MRI. Only then does the doctor make a final diagnosis, prescribe and agree with the patient on complex treatment. შედგება consists of:
- Modern schemes of medical and non-narcotic treatment of osteoarthritis - medications, physiotherapy, exercise therapy and massage, ankle fixation methods;
- Traditional methods of oriental therapy - acupuncture, moxibustion, acupressure, various methods of kinesiotherapy, including taping.
These are not all methods used in clinics. Doctors can combine Western and Eastern methods, which significantly accelerates the improvement of the patient's condition. Patients are relieved of pain quickly, their quality of life is significantly improved.
Combined with the proven techniques of the East and the innovative methods of Western medicine.
Prevention of foot osteoarthritis
The following recommendations should be followed to reduce the risk of disease progression:
- Activity, exercise therapy exercises, swimming should become a part of your life;
- High physical activity and any traumatic factor should be ruled out; Hiking should be combined with rest, if your legs are damaged during work, then it is worth replacing it;
- Injuries, especially on ice in winter, should be ruled out by thinking about traffic lanes and used shoes;
- Rational nutrition is essential to restore metabolism, but excess weight on the ankle puts extra strain on it;
- Prophylactic treatment courses are a guarantee of a painless life.
Frequently asked questions about the disease
- Which doctor should I go to for osteoarthritis of the ankle and osteoarthritis of the foot?
To an orthopedist-traumatologist. But if the disease developed on the background of any kind of rheumatic process, then consult a rheumatologist.
- What predictions do doctors usually make?
It is possible to stop the progression of the degenerative process and improve the quality of life at any stage, but it is better to do it at the beginning of the disease, do not wait for complications to appear.
- Can osteoarthritis of the ankle develop in children?
Maybe after an injury or on the background of a congenital pathology.
- What are the consequences of the disease?
Untreated arthrosis leads to disability. If you start treatment on time, it is quite possible to maintain limb function. Treatment in later stages will relieve pain and improve quality of life.
- Are Sports Injuries The Cause Of Osteoarthritis Of The Ankle?
Yes, sports injuries are one of the main causes of this disease.
- Is it possible to do ankle taping during arthrosis?
It is possible, but it must be done by a specialist.
Osteoarthritis of the ankle joint is almost always the result of macro or microtrauma. It runs slowly and unnoticed at times. Therefore, timely treatment and rehabilitation after injuries is very important, as well as contacting a doctor at the first signs of ankle disease.