Arthrosis of the ankle joint is a degenerative and dystrophic disease of the structures of the musculoskeletal system. Affects the lower limb. It is considered one of the most common forms of osteoarthritis: it is responsible for up to 30% of all cases of degenerative dystrophic joint injuries. The pathological process occurs not only in elderly patients. About a quarter of patients are people under 40 years of age.
The disorder is accompanied by persistent pain and gradual decline in joint and lower limb function. Without treatment, the disease progresses and does not go away on its own. The diagnosis and treatment of the disorder is the responsibility of an orthopedic doctor (depending on the cause, a traumatologist is involved, as well as physiotherapists and physiotherapists).
Causes of ankle osteoarthritis
Osteoarthritis is considered a polyetiological disease. Its development occurs due to the influence of a set of causes. With age, the number of disease-provoking factors increases, hence the likelihood of a pathological process increases. But not everything is so simple.
Pathogenesis of the disorder
There is a group of causes of ankle arthrosis, 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 choosing a profession. Constant walking, standing in one place, carrying heavy objects, intense activity. All of these are provocateurs of the pathological process in the medium term (several years).
Another reason is injuries, mainly intra-articular fractures, dislocations and also severe bruises (to a lesser extent). Arthrosis of the ankle joint manifests itself imperceptibly, but constantly progresses. Patients often underestimate the consequences of the trauma they have suffered.
Surgeries can cause osteoarthritis. However, such a complication is relatively rare. Mainly due to an incorrect assessment of the clinical situation. insufficient qualifications 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 footwear is one of the key factors in the development of the pathological process. The disorder develops due to improper load distribution 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 dysfunctions of the musculoskeletal system themselves 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. Lesions of a degenerative-dystrophic nature are secondary, but aggravate the underlying disease and worsen the prognosis.
Arthrosis 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. In addition, 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. At the initial stage, local blood circulation and dynamic load distribution on the foot are disturbed. Gradually, destructive processes are added to 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.
Increased risk factors for developing osteoarthritis
Dystrophic destruction of the tissues of the ankle joint does not occur only as a result of the influence of immediate causes. The severity, probability of the disease and the nature of its course are affected 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: teachers, cooks also get sick);
- previous injuries to the ankle joint (there are cases in which the disorder manifested itself years after the injury);
- history of endocrine diseases (hormonal disorders create additional risks);
- history of musculoskeletal diseases;
- age over 40 years (although the disease also occurs in younger people);
- increase in body weight;
- gender (women suffer more often than men).
Arthrosis of the ankle joint is a disease that develops slowly; symptoms do not become apparent immediately. Therefore, it is difficult to assess which risk factors and causes provoke the pathological process. It is necessary to collect a complete medical history.
Classification and types of ankle joint damage
The pathology is classified according to two bases.
The first criterion is the origin of the pathological process. Emphasis:
- post-traumatic form of the disease (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 slow but constant deformation of the joint;
- Metabolic arthrosis develops against the background of diabetes, hormonal disorders or gout (purine metabolism disorders).
The second classification basis 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 osteoarthritis.
In the first phase, there is no clinical picture as such 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, as well as limited mobility of the leg in the ankle joint.
The final stage of the pathological process is accompanied by severe pain, as well as other symptoms in a state of complete rest. Supportive and motor functions are impaired. Often a person becomes disabled. Complex surgical treatment, including endoprosthetics, is required.
Important!
Staging plays the most important role in determining treatment tactics and predicting the course and outcome of the disease. The disorder is best treated 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:
- pain;
- fatigue;
- exercise intolerance;
- swelling;
- disorders of the support function of the leg;
- muscle weakness.
Leg pain is initially observed only after intense physical activity. So a little activity is enough. 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. The signs indicate further development of the disorder.
Exercise tolerance also gradually decreases. In a pronounced stage of the disorder, the person is unable to climb to the second or third floor. We have to make stops.
Swelling is a sign that is always present. The leg at the ankle appears swollen and enlarged. This is a nonspecific manifestation.
Initial pain is typical. After a long stay in the same place, 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 huge role in determining the stage and severity of the pathological process. The doctor systematizes the symptoms through a process of oral questioning and anamnesis.
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 osteoarthritis of the ankle joint occurs, the manifestations become intense again. And so on in a circle until quality treatment is performed.
Complications of ankle osteoarthritis
Complications of the pathological process are related to maintaining work capacity and the ability to take care of oneself.
Patients present with ankle deformities. The pathological process ends with the formation of contractures, areas of primary or complete immobility of the limb at 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 end result of the pathological process is a decrease and then a 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 the ability to work and, in some cases, the ability to care for oneself. In advanced stages of ankle osteoarthritis, patients become disabled.
Diagnosis of the disease
Diagnosis of damage to articular structures and cartilaginous tissue is carried out under the supervision of an orthopedic traumatologist. 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 symptoms and health complaints;
- collection of anamnesis, which allows determining the probable origin of the pathological condition;
- palpation: arthrosis is indicated by deformation, swelling, pain during passive movements;
- Ankle x-ray: routine examination that provides sufficient information to make the diagnosis and determine its severity, it is considered the gold standard examination;
- MRI if radiographic data is insufficient.
Other studies can be carried out. For example, computed tomography (arthrosis affects not only cartilage, but also bones; computed tomography allows a detailed and accurate visualization of the nature of the disorders).
Observation!
Osteoarthritis does not present specific manifestations, especially at an early stage. Therefore, on your own, without sufficient knowledge, it will not be possible to distinguish pathological processes from each other. Special instrumental diagnostics are required.
Laboratory diagnostic techniques provide little data. They are only informative in identifying 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 you resort to complex corrections.
Conservative therapy includes the use of medications, exercise therapy, and physical therapy with massage. The following medications are used:
- local anti-inflammatory;
- general anti-inflammatories (in the form of tablets or injectable solutions);
- chondroprotectors;
- nicotinic acid and other means to improve metabolic processes.
Exercise therapy and physiotherapy, together with massage, aim to recover after the acute condition has been eliminated. These methods are significant during the remission period. If the disease proceeds acutely 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 endoprosthetics, joint replacement with an artificial analogue are possible. This is a high-tech correction method.
Predictions
The prognosis depends on the timing of treatment, health status, the cause of osteoarthritis, as well as the degree of evolution of the disorder. 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 required.
Prevention of the disorder
Prevention of ankle osteoarthritis includes:
- wear comfortable shoes;
- timely treatment of musculoskeletal diseases;
- reasonable control of welfare;
- body weight control;
- avoiding injuries;
- load control.
Prevention can reduce the risk of ankle osteoarthritis by 2 to 3 times. The likelihood of a pathological process will be minimal.