Osteoarthritis of the ankle joint is a degenerative, dystrophic disease of the structures of the musculoskeletal system. It affects the lower limb. It is considered one of the most common forms of arthrosis: it accounts for up to 30% of the total number of cases of degenerative-dystrophic joint damage. The pathological process occurs not only in older patients. About a quarter of the patients are people under 40 years old.
The disorder is accompanied by constant pain and a gradual decrease in joint and lower limb function. Without treatment, it progresses and does not go away on its own. The diagnosis and treatment of the disorder is the work of an orthopedic doctor (depending on the cause, a traumatologist is involved, as well as doctors of physical therapy and physiotherapists).
Causes of arthrosis of the ankle
Osteoarthritis is considered a polyetiological disease. Its development occurs as a result of the influence of a group of reasons. With age, the number of factors provoking the disease increases, hence the increased likelihood of a pathological process. But not everything is so simple.
Pathogenesis of the disorder
There are a group of causes of arthrosis of the ankle, among the most common:
- irrational physical activity;
- injuries;
- operations;
- metabolic diseases;
- uncomfortable shoes;
- other diseases of the musculoskeletal system;
- rheumatoid diseases.
Irrational stress can be a result of lifestyle or a consequence of career choice. Constant walking, standing in one place, carrying heavy objects, intense activity. All of them are provocateurs of the pathological process in the medium term (several years).
Another cause is injuries, especially intra-articular fractures, dislocations, as well as severe bruises (to a lesser extent). Arthrosis of the ankle joint manifests itself unnoticed, but constantly progresses. Patients often underestimate the consequences of their trauma.
Operations can provoke arthrosis. However, such a complication is relatively rare. Mainly due to incorrect assessment of the clinical situation. insufficient qualification of the doctor.
Metabolic pathologies, such as diabetes mellitus, can provoke a disorder. However, much more often the causes of ankle arthrosis are gout, as well as hormonal disorders (for example, during menopause).
Uncomfortable shoes are one of the key factors in the development of the pathological process. The disorder develops due to improper distribution of the load on the leg. Complex diseases usually develop: not only arthrosis, but also spinal injuries. At least - osteochondrosis. But more dangerous problems are possible.
Dysfunctions of the musculoskeletal system also increase the likelihood of a pathological process. Intervertebral hernias, osteochondrosis and congenital diseases create additional risks.
Rheumatoid diseases are represented by arthritis, systemic lupus erythematosus. Degenerative-dystrophic lesions are secondary, but they aggravate the underlying disease and worsen the prognosis.
Osteoarthritis of the ankle joint is a multifactorial disease. As a rule, it develops under the influence of several reasons at the same time. There are exceptions, but they are rare. Also, the number of factors affects the severity of the disease and the rate of progression of the pathological process.
The development of the pathological process is gradual. In the initial stage, the local blood circulation and the distribution of the dynamic load on the foot are disturbed. Destructive processes in the cartilage are gradually added. A slow inflammation begins. Degeneration also occurs in other structures of the ankle: capsule, ligaments, bones, etc. The more advanced the disease, the more difficult the treatment. It requires more effort and time.
Factors for increased risk of developing arthrosis
Dystrophic destruction of the tissues of the ankle joint occurs not only as a result of the influence of immediate causes. The severity, likelihood of the disease and the nature of its course are influenced by risk factors. They complete the offense picture. Between them:
- habit of wearing heels;
- the physically demanding nature of the work (including professions with non-obvious risks: teachers, cooks also get sick);
- previous injuries to the ankle joint (there are cases when the disorder manifests itself years after the injury);
- history of endocrine diseases (hormonal disorders create additional risks);
- history of diseases of the musculoskeletal system;
- age 40+ (although the disease also occurs in younger people);
- increased body weight;
- gender (women suffer more often than men).
Osteoarthritis of the ankle joint is a disease that develops slowly, the symptoms do not appear immediately. Therefore, it is difficult to assess what risk factors and causes provoke the pathological process. A complete medical history should be taken.
Classification and types of injuries of the ankle joint
Pathology is classified on two bases.
The first criterion is the origin of the pathological process. Accent:
- post-traumatic form of disorder (develops after injuries to the ankle joint or other structures of the musculoskeletal system);
- deforming arthrosis of the ankle joint: a consequence of metabolic disorders or injuries accompanied by slow but permanent deformation of the joint;
- Metabolic arthrosis develops against the background of diabetes, hormonal disorders or gout (disorder of purine metabolism).
The second basis for classification is based on the stage of the pathological process. In its development, arthrosis of the ankle joint goes through the following stages:
- initial or early;
- progressive;
- advanced arthrosis.
In the first stage, there is no clinical picture as such or it appears after intense physical exertion. The pathological process is detected only with the help of special diagnostic methods.
The progressive phase of the disorder is accompanied by an intensification of the clinic. Symptoms appear after light physical activity. Load tolerance decreases. There is a constant pain syndrome, as well as limited mobility of the leg in the ankle joint.
The final phase of the pathological process is accompanied by severe pain, as well as other symptoms in a state of complete rest. Both supporting and motor functions are impaired. Often a person becomes disabled. Complex surgical treatment is required, including endoprosthetics.
important!
Staging plays the biggest role in determining treatment tactics and predicting the course and outcome of the disease. The disorder is best treated in its early stages. The more advanced the pathology, the more difficult and time-consuming the correction.
Symptoms of the disorder
The clinical picture depends on the form and stage of the pathological process. Typical manifestations are:
- pain;
- tiredness;
- exercise intolerance;
- swelling;
- disorders of the supporting function of the leg;
- muscle weakness.
Leg pain is initially observed only after intense physical exertion. Then a little activity is enough. In an advanced stage of the pathological process, the pain is always present, regardless of the load.
Fatigue is observed from the first stage of the disorder. Feelings of muscle weakness and increased fatigue progress along with the disease. Signs indicate further development of the disorder.
Exercise tolerance also gradually decreases. In a pronounced stage of the disorder, a person cannot rise to the second or third floor. We have to stop.
Swelling is a sign that is always present. The leg up to the ankle appears swollen and enlarged. This is a non-specific manifestation.
Initial pain is typical. After a long stay in one place, a strong stiffness of the joint develops. The first movements cause a lot of discomfort. The pain and discomfort gradually disappear as the person continues to move.
The clinical picture depends on the degree of arthrosis of the ankle joint. It plays a big role in determining the stage and severity of the pathological process. The physician systematizes the symptoms through a process of oral questioning and history taking.
The disease is characterized by a chronic course. During periods of exacerbation, the signs of arthrosis of the ankle joint appear most clearly. In the chronic phase, remission is only partial. The clinic is not so bright, but the symptoms do not disappear completely. Then there is a new exacerbation of arthrosis of the ankle joint, the manifestations become intense again. And so in a circle until quality treatment is performed.
Complications of ankle arthrosis
Complications of the pathological process are related to the maintenance of working capacity and the ability to self-care.
Patients experience ankle deformity. The pathological process ends with the formation of contractures, areas of primary or complete immobility of the limb in the ankle. The situation can only be corrected surgically.
During an exacerbation, the development of synovitis and inflammation of the synovial bursa is characteristic. This condition lasts for several weeks and during its acute course it completely eliminates the ability to work and move.
The final result of the pathological process is a reduction and then a complete loss of the supporting function of the leg, a person cannot move normally. You must use crutches. There is a complete loss of ability to work, and in some cases, the ability to care for oneself. In an advanced stage of ankle arthrosis, patients become disabled.
Diagnosis of the disease
The diagnosis of damage to joint structures and cartilage tissue is carried out under the supervision of an orthopedic traumatologist. Reviews are typical. It is not difficult to identify the pathological process, as well as the degree of its severity. Among the techniques:
- verbal questioning of the patient to better understand the nature of symptoms and health complaints;
- collection of anamnesis, which allows you to determine the likely origin of the pathological condition;
- palpation: arthrosis is indicated by deformation, swelling, pain during passive movements;
- X-ray of the ankle: a routine examination that provides enough information to make a diagnosis and determine its severity, is considered the gold standard examination;
- MRI if radiographic findings are insufficient.
Other tests may be performed. For example, computed tomography (arthrosis affects not only the cartilages, but also the bones; CT allows a detailed and accurate visualization of the nature of the disorders).
Note!
Arthrosis has no specific manifestations, especially in the early stages. Therefore, alone, without sufficient knowledge, it will not be possible to distinguish pathological processes from each other. Special instrumental diagnostics is required.
Laboratory diagnostic techniques provide little data. They are only informative in terms of identifying the inflammatory process and help in the diagnosis of some forms of arthrosis (metabolic origin, rheumatoid nature).
Methods of treatment
Treatment of arthrosis of the ankle joint is carried out with conservative and surgical methods. The best results can be achieved if you resort to complex correction.
Conservative therapy includes the use of medication, exercise, and physical therapy with massage. The following drugs are used:
- local anti-inflammatory;
- general anti-inflammatory drugs (in the form of tablets or injection solutions);
- chondroprotectors;
- nicotinic acid and other means to improve metabolic processes.
Exercise therapy and physical therapy, along with massage, are aimed at recovery after the acute condition is eliminated. These methods are important during the remission period. If the disease proceeds in an acute form with pronounced clinical symptoms, the methods are postponed.
In case of deformities and permanent deviations in the anatomy of the joint, surgical treatment is required. Plastic surgery of the joint or endoprosthesis, replacement of a joint with an artificial analogue, is possible. This is a high-tech correction method.
Predictions
The prognosis depends on the time of treatment, the state of health, the cause of the arthrosis, as well as the degree of development of the disease. The more advanced the disease, the more complicated the situation. If treatment is started early, the prospects for cure and full recovery are good. In other cases, surgery and a long period of rehabilitation are necessary.
Prevention of the disorder
Prevention of arthrosis of the ankle includes:
- wearing comfortable shoes;
- timely treatment of diseases of the musculoskeletal system;
- reasonable welfare control;
- body weight control;
- avoiding injury;
- load control.
Prevention can reduce the risk of ankle arthrosis by 2-3 times. The probability of a pathological process will be minimal.