Arthrosis of the ankle joint is a degenerative and 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 represents up to 30% of the total cases of degenerative-dystrophic joint damage. The pathological process occurs not only in older patients. About a quarter of patients are people under the age of 40.
The disorder is accompanied by persistent pain and a gradual decrease in joint and lower limb function. Without treatment it progresses and does not disappear on its own. The diagnosis and treatment of the disorder is the responsibility of the orthopedic doctor (depending on the cause, the traumatologist also intervenes, in addition to physiotherapists and physiotherapists).
Causes of ankle arthritis
Osteoarthritis is considered a polyetiological disease. Its development occurs as a result of the influence of a group of causes. 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 ankle arthritis, 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 the result of a lifestyle or a consequence of a career choice. Constant walking, standing in one place, carrying heavy objects, intense activity. All these are provocateurs of the medium-term (several years) pathological process.
Another reason is injuries, especially intra-articular fractures, dislocations and even severe bruises (to a lesser extent). Arthrosis of the ankle joint occurs unnoticed, but steadily progresses. Patients often underestimate the consequences of the trauma they have suffered.
Surgical interventions can cause osteoarthritis. However, this complication is relatively rare. Mainly due to an incorrect assessment of the clinical situation. insufficient qualification of the doctor.
Metabolic diseases, such as diabetes mellitus, can cause a disorder. However, much more often the causes of ankle arthrosis are gout and 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 incorrect distribution of load on the foot. Complex disorders usually develop: not only arthrosis, but also spinal injuries. At a minimum: osteochondrosis. But more dangerous problems are also possible.
The same dysfunctions of the musculoskeletal system also increase the likelihood of a pathological process. Intervertebral hernias, osteochondrosis and congenital disorders create additional risks.
Rheumatoid diseases are represented by arthritis, systemic lupus erythematosus. Lesions of a degenerative-dystrophic nature are secondary, but 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 causes at once. There are exceptions, but they are rare. Furthermore, the number of factors influences 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, local blood circulation and the distribution of dynamic load on the foot are disrupted. Gradually, destructive processes are added in the cartilage. Slow inflammation begins. Degeneration of other ankle structures occurs: capsule, ligaments, bones, etc. The more advanced the disease, the more difficult the treatment. It requires more effort and time.
Factors of increased risk of developing osteoarthritis
Dystrophic destruction of the tissues of the ankle joint occurs not only due to 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 picture of the violation. Between them:
- habit of wearing heels;
- the physically difficult nature of the work (including professions with non-obvious risks: even teachers, cooks get sick);
- previous injuries to the ankle joint (there are cases when the disorder manifested itself years after the injury);
- history of endocrine diseases (hormonal disorders create additional risks);
- history of musculoskeletal diseases;
- age over 40 (although the disease also occurs in young people);
- increased body weight;
- gender (women suffer more often than men).
Osteoarthritis of the ankle joint is a disease that develops slowly; symptoms do not appear immediately. Therefore, it is difficult to evaluate which risk factors and causes provoke the pathological process. It is necessary to take a complete medical history.
Classification and types of damage to the ankle joint
The pathology is classified according to two bases.
The first criterion is the origin of the pathological process. Make evident:
- post-traumatic form of the disorder (develops after injuries to the ankle joint or other structures of the musculoskeletal system);
- deforming arthrosis of the ankle joint: consequence of metabolic disorders or injuries, accompanied by a slow but constant deformation of the joint;
- Metabolic arthrosis develops against the background of diabetes, hormonal disorders or gout (purine metabolism disorders).
The second basis for classification is based on the staging 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 phase there is no real clinical picture or it appears after intense physical activity. 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 and limited mobility of the leg in the ankle joint.
The final stage of the pathological process is accompanied by severe pain and other symptoms in a state of complete rest. Both support and motor functions are impaired. Often a person becomes disabled. Complex surgical treatment, including endoprosthesis, is required.
Important!
Staging plays the most important role in determining treatment tactics and predicting the course and outcome of the disease. It is best to treat the disorder at an early stage. The more advanced the pathology, the more difficult and time-consuming it is to correct.
Symptoms of the disorder
The clinical picture depends on the form and stage of the pathological process. Typical manifestations are:
- Ache;
- fatigue;
- exercise intolerance;
- swelling;
- disorders of the leg support function;
- muscle weakness.
Leg pain is initially observed only after strenuous physical activity. Then all it takes is a little activity. In the advanced stage of the pathological process, pain is always present, regardless of the load.
Fatigue is observed from the first stage of the disorder. The feeling of muscle weakness and increased fatigue progresses 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 make some stops.
Swelling is an ever-present sign. The leg at the ankle appears swollen and enlarged. This is a non-specific manifestation.
Initial pain is typical. After a long stay in one place, severe stiffness of the joint develops. The first movements cause a lot of discomfort. The pain and discomfort gradually fade as the person continues to move.
The clinical picture depends on the degree of arthrosis of the ankle joint. It plays an important role in determining the stage and severity of the disease process. The doctor systematizes symptoms through a process of oral questions and history taking.
The disease is characterized by a chronic course. During periods of exacerbation, signs of arthrosis of the ankle joint appear more clearly. In the chronic phase, remission is only partial. The clinic is not so bright, but the symptoms do not disappear completely. Then a new exacerbation of arthrosis of the ankle joint occurs, the manifestations again become intense. And so on in a circle until quality treatment is performed.
Complications of ankle arthritis
Complications of the disease process concern maintaining working capacity and the ability to care for oneself.
Patients present with ankle deformities. 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.
At the time of exacerbation, the development of synovitis and inflammation of the synovial bag is typical. This condition lasts several weeks and during its acute course completely eliminates the ability to work and move.
The final result of the pathological process is a decrease and therefore the complete loss of the supporting function of the leg; the person cannot move normally. You have to use crutches. There is a complete loss of ability to work and, in some cases, the ability to care for oneself. In advanced stages of ankle arthritis, patients become disabled.
Diagnosis of the disease
Diagnosis of damage to joint structures and cartilaginous tissue is carried out under the supervision of an orthopedic traumatologist. The exams are typical. It is not difficult to identify the pathological process, as well as the degree of its severity. Among the techniques:
- oral questioning of the patient to better understand the nature of the symptoms and health disorders;
- collection of the medical history, which allows determining the probable origin of the pathological condition;
- palpation: arthrosis is signaled by deformation, swelling, pain during passive movements;
- Ankle x-ray: A routine exam that provides sufficient information to make a diagnosis and determine its severity, is considered the gold standard test;
- MRI if radiographic data are insufficient.
More studies could be conducted. For example, computed tomography (arthrosis affects not only cartilage, but also bones; CT allows detailed and accurate visualization of the nature of the disorders).
Note!
Osteoarthritis has no specific manifestations, especially in the initial phase. Therefore, on your own, 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 have only informative value to identify the inflammatory process and help in the diagnosis of some forms of arthrosis (metabolic origin, rheumatoid nature).
Treatment methods
Treatment of arthrosis of the ankle joint is carried out using conservative and surgical techniques. The best results can be achieved if complex corrections are used.
Conservative therapy includes the use of medications, physical therapy and physiotherapy with massage. The following drugs are used:
- local anti-inflammatory;
- general anti-inflammatory drugs (in the form of tablets or injectable solutions);
- chondroprotectors;
- nicotinic acid and other means to improve metabolic processes.
Physical therapy and physiotherapy, along with massage, are aimed at recovery after the acute condition has been eliminated. These methods are significant during the remission period. If the disease manifests itself in an acute form with pronounced clinical symptoms, the methods are postponed.
Surgical treatment is necessary for persistent deformities and deviations in the anatomy of the joint. Joint plastic surgery or endoprosthesis, replacement of the joint with an artificial analog are possible. This is a high-tech correction method.
Forecasts
The prognosis depends on the time of treatment, the state of health, the cause of arthrosis, as well as the degree of development of the disorder. The more advanced the disease, the more complicated the situation. If treatment is started early, the prospects for recovery and complete recovery are good. In other cases, surgery and a long period of rehabilitation are required.
Prevention of the disorder
Prevention of ankle arthritis includes:
- wear comfortable shoes;
- timely treatment of musculoskeletal diseases;
- reasonable welfare monitoring;
- body weight control;
- avoid injuries;
- load control.
Prevention can reduce the risk of ankle arthritis by 2-3 times. The probability of a pathological process will be minimal.