Osteoarthritis of the ankle joint is a degenerative, dystrophic disease of the structure of the musculoskeletal system. It affects the lower extremity. 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 elderly patients. About a quarter of patients are under 40 years old.
The disorder is accompanied by persistent pain and a gradual decrease in joint and lower limb function. Without treatment, it progresses and does not go away on its own. Diagnosis and treatment of disorders is the job of orthopedic doctors (depending on the cause, traumatologists, physical therapy doctors and physiotherapists are also included).
Causes of ankle arthrosis
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 that cause the disease increases, and thus the probability of the 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 the choice of 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, especially intra-articular fractures, dislocations, and also severe bruising (to a lesser extent). Arthrosis of the ankle joint manifests itself imperceptibly, but it constantly progresses. Often patients underestimate the consequences of the trauma suffered.
Surgical interventions can cause 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 cause the 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 foot. Complex disorders usually develop: not only arthrosis, but also spinal injuries. At least - osteochondrosis. But more dangerous problems are also possible.
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 arthritis, systemic lupus erythematosus. Lesions of a degenerative-dystrophic nature are secondary, but they worsen the underlying disease and worsen the prognosis.
Ankle arthrosis is a multifactorial disease. As a rule, it develops under the influence of several causes at once. There are exceptions, but they are rare. Also, the number of factors affects the severity of the disease and the speed of progression of the pathological process.
The development of the pathological process is gradual. In the initial phase, local blood circulation and the distribution of dynamic load on the foot are disturbed. Destructive processes in the cartilage are gradually added. A slow inflammation begins. Degeneration of other structures of the ankle joint 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 arthrosis
Dystrophic destruction of the tissue 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 picture of the offense. Among them:
- the habit of wearing heels;
- physically demanding nature of work (including professions with non-obvious risks: teachers, cooks also get sick);
- previous ankle joint injuries (there are cases where the disorder manifested itself years after the injury);
- history of endocrine diseases (hormonal disorders create additional risks);
- history of musculoskeletal diseases;
- 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 slowly developing disease; symptoms do not become apparent immediately. Therefore, it is difficult to assess which risk factors and causes cause the pathological process. It is necessary to collect a complete medical history.
Classification and types of damage to the ankle joint
Pathology is classified according to two bases.
The first criterion is the origin of the pathological process. Highlight:
- 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: a consequence of metabolic disorders or injuries, accompanied by slow but steady deformation of the joint;
- Metabolic arthrosis develops against the background of diabetes, hormonal disorders or gout (disorders of purine metabolism).
Another 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 activity. The pathological process is detected only with the help of special diagnostic methods.
The progressive phase of the disorder is followed by the intensification of the clinic. Symptoms appear after mild 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. Both supportive 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 long-lasting the correction.
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 supporting function of the leg;
- muscle weakness.
Leg pain is initially noticed only after intense physical activity. Then a little activity is enough. In the advanced stage of the pathological process, pain is always present, regardless of the load.
Fatigue is observed already from the first stage of the disorder. The feeling of muscle weakness and increased fatigue progresses 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 climb to the second or third floor. We have to stop.
Swelling is a sign that is always present. The leg appears swollen and enlarged at the ankle joint. This is a non-specific manifestation.
Initial pain is typical. After staying in one place for a long time, severe joint stiffness occurs. The first movements cause great 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 major role in determining the stage and severity of the pathological process. The doctor systematizes the symptoms through the process of oral examination and history taking.
The disease is characterized by a chronic course. In periods of exacerbation, the signs of ankle arthrosis 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 worsening of arthrosis of the ankle joint, the manifestations become intense again. And so in a circle until a quality treatment is performed.
Complications of ankle arthrosis
Complications of the pathological process relate to the preservation of working ability and the ability to care for oneself.
Patients have ankle deformities. The pathological process ends with the creation of contractures, areas of primary or complete immobility of the extremities in the ankle. The situation can only be corrected surgically.
At the time of exacerbation, the development of synovitis and inflammation of the synovial bursa is typical. This condition lasts for several weeks and during its acute course completely eliminates the ability to work and move.
The final result of the pathological process is the reduction and then the complete loss of the supporting function of the leg, the person cannot move normally. You must use crutches. There is a complete loss of working ability, and in some cases also the ability to take care of oneself. In advanced stages of ankle arthrosis, patients become disabled.
Disease diagnosis
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:
- oral examination of the patient in order to better understand the nature of symptoms and health problems;
- 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;
- Radiography of the ankle joint: a routine examination that provides enough information to establish a diagnosis and determine its severity, is considered the gold standard of examination;
- MRI if radiographic data are insufficient.
Other studies may be conducted. For example, computed tomography (arthrosis affects not only cartilage, but also bones; CT enables detailed, accurate visualization of the nature of the disorder).
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. A special instrumental diagnosis is required.
Laboratory diagnostic techniques provide little information. They are only informative in terms of identifying the inflammatory process and help diagnose some forms of arthrosis (metabolic origin, rheumatoid nature).
Treatment methods
Treatment of arthrosis of the ankle joint is carried out by conservative and surgical techniques. The best results can be achieved if you resort to complex correction.
Conservative therapy includes the use of drugs, exercise therapy and physiotherapy with massage. The following drugs are used:
- local anti-inflammatory;
- general anti-inflammatory drugs (in the form of tablets or solutions for injections);
- chondroprotectors;
- nicotinic acid and other means for improving metabolic processes.
Exercise therapy and physiotherapy, together with massage, aim at recovery after the acute condition has been resolved. These methods are important during the period of remission. If the disease occurs in an acute form with pronounced clinical symptoms, the methods are postponed.
Surgical treatment is necessary for deformities and persistent deviations in the anatomy of the joint. Plastic joint surgery or endoprosthetics, joint replacement with an artificial analogue, is possible. This is a high-tech correction method.
Forecasts
The prognosis depends on the time of treatment, health condition, cause of arthrosis, as well as the degree of development of the disorder. The more advanced the disease, the more complex the situation. If treatment is started early, the chances of a cure and full recovery are good. In other cases, surgery and a long period of rehabilitation are required.
Prevention of disorders
Prevention of arthrosis of the ankle joint includes:
- wearing comfortable shoes;
- timely treatment of musculoskeletal diseases;
- reasonable welfare control;
- body weight control;
- avoiding injuries;
- load control.
Prevention can reduce the risk of ankle arthrosis by 2-3 times. The probability of a pathological process will be minimal.