Ankle arthrosis

In recent years, experts around the world have noticed an increase in degenerative-dystrophic processes in the ankle, gradually leading to disability. Ankle osteoarthritis often develops as a result of serious injuries or permanent microtrauma to athletes, professional dancers, circus performers. You will learn from this article how to notice the signs of this disease in a timely manner and stop its progression, as well as how it is treated.

Ankle osteoarthritis - what is it

The joint is a complex block-shaped joint formed by the lower (distal) ends of the tibia and fibula of the lower leg, forming the inner and outer ankle (ankles), as well as the ankle. From the inside, it is strengthened by the deltoid ligament, from the outside - by the anterior and posterior talofibular and calcaneofibular ligaments. Function: flexion and extension of the leg. The joint is functionally connected to the foot, has joint ligaments and muscle tendons with the ankle joints.

Ankle osteoarthritis is a degenerative-dystrophic disease that begins with thinning and destruction of the articular cartilage, reducing its cushioning properties, followed by the involvement of all other articular tissues in the pathological process. The disease gradually leads to complete wear and tear of the wrist and disability. The ICD-10 ankle osteoarthritis code is M19.

The disease is less common than a similar knee lesion and is usually the result of serious injury or long-term injury as a result of some activity.

Causes of osteoarthritis of the ankle

Specialists have studied in detail the reasons for the development of ankle osteoarthritis and osteoarthritis of the foot. This:

• injuries - intra-articular fractures of the joints, fractures of the joints, complete and incomplete rupture of ligaments and tendons;
• microtrauma due to any professional activity - these are ballerinas, dancers, professional athletes;
• increased load on the legs with excess body weight;
• improper load distribution when wearing high-heeled shoes;
• metabolic disorders that have a negative effect on metabolism in cartilage tissues - diabetes mellitus, obesity, gout, etc. ;
• hormonal shifts, including age-related ones;
• transferred severe acute purulent arthritis;
• chronic long-term arthritis of any origin;
• lumbar spine osteochondrosis and intervertebral hernia, causing damage to the spinal roots and weakening of the muscles of the lower leg and foot, leading to instability and joint injuries.

Mechanism of disease development (pathogenesis)

Under the influence of various reasons, blood circulation in the articular region is disturbed, which leads to a decrease in the volume of synovial fluid that nourishes cartilage tissue. Due to the lack of oxygen and nutrients, the cartilage becomes thinner, cracks and erosions appear on it. This leads to damage to the subcartilaginous layer of the bone. Thickens (scleroses) and grows along the edges of articular surfaces. These growths are called osteophytes. They suppress soft tissues, blood vessels and nerves, causing pain and further disrupting blood circulation.

Due to circulatory disorders and high blood pressure, muscles suffer, they weaken, which leads to joint instability and frequent displacements. Osteoarthritis of the foot develops, small tarsal joints, metatarsal-tarsal, metatarsophalangeal and interphalangeal joints are affected.

Gradually, connective tissue grows into the joints, tightly connecting the articular surfaces and disrupting articular function. Complete loss of ankle function is associated with melting of articular bone joints. Osteoarthritis of the foot also develops gradually.

Symptoms of osteoarthritis of the ankle

Osteoarthritis of the ankle at first proceeds slowly and invisibly. But the symptoms gradually appear and increase, signaling a kind of violation in the lower limb.

The first signs

The first symptom of ankle osteoarthritis is pain during high loads, for example, during long walks, jumping, playing football or volleyball, etc. This pain passes quickly, so the person does not pay attention immediately, attributing it to muscle fatigue. The pain can be symmetrical in both joints (with high loads and microtrauma), and unilateral (after a major injury).

Then there is a feeling of stiffness in the morning or after a long stay in a stationary state. The ankles become stiff 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 alarm and become a cause to go to the doctor.

Visible symptoms

Gradually, the pain after exertion intensifies and lasts longer. The foot may ache throughout the day. Night pains go away, they usually appear in the second half of the night and are sometimes accompanied by painful muscle cramps. Periods of hardening after immobility are also extended.

Because of the severe pain, a person begins to limp while walking, trying to reduce the pain in the leg by stretching or pressing it. Sometimes the ankle swells, 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 resolves on its own without treatment. But at the same time, the deterioration of the synovitis activates the progression of the degenerative-dystrophic articular process.

Dangerous symptoms

Persistent excruciating pain, aggravated by physical exertion, instability, joint looseness, tendency to subluxations, dislocations, and ligament injuries are dangerous symptoms that require a visit to the doctor. The joint changes from the outside: it takes on a different shape due to the increased osteophytes. Osteoarthritis of the ankle (ankle) leads to its thickening. Foot movements are initially somewhat restricted, and then the ankle becomes immobile or, conversely, loose, unstable. But even at this stage, the patient can be helped, you just need to contact the clinic. Symptoms of osteoarthritis of the foot appear: pain in the leg, violation of its flexion and cushioning. The development of osteoarthritis of the big toe is accompanied by pain and deformity of the foot in the form of swelling and flexion of the big toe from the outside.

What is dangerous ankle osteoarthritis

The danger is that the disease initially develops invisibly and very often the patient goes to the doctor, already at an advanced stage.

Every localization and form of osteoarthritis has serious complications, so you should not delay treatment.

Distribution

Osteoarthritis of the ankle can be primary, when the cause of its development has not been determined, and secondary, with a known cause of origin. Depending on the cause of development, the disease may have its own distinctive features.

Post-traumatic arthrosis of the ankle

Consequences of traumatic injury are the most common cause of illness. Post-traumatic arthrosis of the ankle joint can develop after a major injury - ligament rupture, dislocation, intra-articular fracture. Usually a joint is injured, so post-traumatic osteoarthritis is unilateral. A small but untreated injury may not be felt at first. And only after a while, when a person has already forgotten it, a slight growing pain appears. This type of injury is dangerous because the patient goes to the doctor already in a neglected condition. Serious injuries are better treated, their consequences appear faster and the patient seeks medical help not too late.

The long-term invisible microtrauma of both joints is typical of professional dancers, athletes, and people whose profession is associated with a long standing posture. There is symmetrical pain in the ankles during physical exertion. They are usually confused with muscle soreness with fatigue, so it is also too late to see a doctor.

Osteoarthritis of the ankle after arthritis

The causes of these osteoarthritis can be chronic inflammatory processes in the joints (arthritis): rheumatoid, reactive, psoriatic. In this case, inflammatory processes are combined with degenerative-dystrophic (arthritis-arthritis). This speeds up the process of destroying the ankle. With a worsening of inflammation, the joints swell, the skin on them becomes red, the pain becomes very strong, especially at night. When inflammation subsides, metabolic disturbances predominate, while all processes take place very rapidly. The disease requires constant monitoring and treatment by a rheumatologist.

Very rarely, the degenerative-dystrophic process develops after suffering from 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 form after infectious arthritis - tuberculosis, gonorrhea, etc. Progression of the disease is associated with the main infectious process and the nature of the destruction. If the infection persists, the destruction of the joints will progress.

Metabolic

It develops with a long course of gout. Very often the first toe is affected. Other small joints of the foot and ankle are affected less frequently. As gout attacks continue, it is difficult to determine externally when the degenerative-dystrophic process occurs. You can only see it on a radiograph. In any case, the patient should be regularly monitored by a rheumatologist and examined periodically.

Deformable arthrosis of the ankle joint

All types of osteoarthritis become deforming over time. Bone deformities indicate an advanced stage of the disease, when the cartilage has already collapsed and the constant mechanical impact on the bone tissue contributes to its growth along the edges of the articular surface. Thus osteophytes are formed that change the articular shape.

Degrees of ankle arthrosis

There are several classifications, one of which distinguishes three clinical and radiological stages of osteoarthritis:

1. EARLY. A little pain after standing or walking for a long time, a little stiffness in the morning. All this disappears quickly without any help. X-rays: normal or slight narrowing of the wrist space.
2. progressive. The pain after exercise is stronger and longer. Stiffness increases, a crack appears in the joints during movement. Sometimes the joint swells, reddens and hurts a lot - a sign of synovitis. Radiography shows a significant narrowing of the joint space, thickening of subcartilaginous bone tissue (osteosclerosis) and proliferation of osteophytes.
3. ultimate. The pain syndrome intensifies, becomes permanent. Because of the pain, a person limps, sticks his feet, uses a cane or crutches. The function of the limbs is impaired, osteoarthritis of the foot and big toe develops. Complete absence of flexion-extensor movements is rare, usually against the background of osteoarthritis. On radiography: no joint space, osteosclerosis, large osteophytes deforming the joint.

Possible complications

If the disease is not treated and let everything take its course, then the following complications are possible:

• persistent joint dysfunction and disability;
• persistent severe pain in the ankle and feet, both after and without exercise;
• ankle instability with the development of common dislocations and subluxations;
• the injury of the foot and the big toe will join, which will further aggravate the patient's condition.

Diagnosis of ankle osteoarthritis

Before prescribing treatment, the doctor performs an examination of the patient, including:

• medical interviews and examination;
• Additional research methods: laboratory tests (signs of inflammation and metabolic disorders are detected), instrumental studies (radiography of the wrist in two projections, computer images and magnetic resonance - early changes in bone structures and soft tissues are detected), diagnostic arthroscopy (the inner articular surface is examined).

Treatment of ankle osteoarthritis

After establishing the final diagnosis, the doctor selects an individual treatment complex for the patient, consisting of medicated and non-drug methods.

Medical treatment of osteoarthritis of the ankle

Drugs that have a symptomatic effect (eliminate the symptoms of the disease) and pathogenetic (suppress the mechanism of disease development) have been described.

Anti-inflammatory and sedative

To eliminate pain, drugs from the group of non-steroidal anti-inflammatory drugs (NSAIDs) are prescribed in short courses, they relieve pain and inflammation well (if synovitis has worsened):

• injection;
• rectal suppositories;
• oral tablets;
• piece of leather.

Muscle relaxants

The muscles that surround the diseased joint and perform its movement are in constant tension, which leads to their atrophy and increases the pain. To eliminate muscle spasms, medications from the group of muscle relaxants are prescribed.

Chondroprotectors

Drugs from the group of chondroprotectors contain glucosamine or chondroitin, and sometimes both of these substances. They protect cartilage cells from destruction and promote their restoration. They are prescribed in the form of injections, tablets and external agents (creams and ointments).

Hyaluronic acid preparations for ankle osteoarthritis

To improve the calming abilities of synovial fluid and prevent further damage to cartilage and bone tissue, hyaluronic acid is injected into the joint cavity. This results in pain relief and improved joint mobility.

Arthritis gel and ointment for ankle osteoarthritis

External tools can be used at home. Osteoarthritis ointment:

• NSAID gels are suitable for relieving pain and inflammation;
• to restore cartilage - gel and ointment based on chondroitin.

Non-drug therapy

The main methods of treating ankle osteoarthritis are non-medication. These are therapeutic exercises, massage, physiotherapy, orthopedic clothing.

Physiotherapy

To alleviate the patient's condition and restore joint function, assign:

• electrophoresis with medicinal substances;
• laser therapy;
• magnetotherapy;
• heating procedures - paraffin, ozocer, in resort conditions - mud applications.

Massage for osteoarthritis of the ankle

Massage courses improve blood circulation, which leads to activation of metabolism, restoration of articular and extra-articular tissue. The positive effect of muscle massage is the elimination of spasm, which contributes to blood flow to the muscles and restoration of their strength, necessary to keep the limb in the desired position.

Exercises and exercise therapy for ankle osteoarthritis

Therapeutic gymnastics is a cure for osteoarthritis. Motor activity is very important, in addition to exercise therapy, swimming is beneficial. Systematic implementation of exercises selected by the doctor allows you to greatly restore limb function, even with an advanced disease.

A rough set of exercises (but before you start applying it, you should consult your doctor):

Use of special orthopedic products

To prevent the progression of the disease, the doctor may prescribe the use of a special orthopedic device - an orthosis. It adjusts the leg to the right 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 performed using tape: with special adhesive tapes, the ankle is gently fixed in the desired position.

Surgical intervention

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 interventions

Operations can be performed in traditional and gentle ways:

1. Therapeutic arthroscopy (sparing operations):
   • articular cavity repair - with the help of an arthroscope, fragments of cartilage and bone tissue are removed from the cavity, which interfere with movement and cause pain;
   • chondroplasty - removes the damaged cartilage layer, which stimulates the growth of new cartilage cells (corrosive chondroplasty); in some cases, transplantation of autocortical sections taken from unloaded areas of the patient's knee joint (mosaic arthroplasty) is performed; Chondroplasty is effective in the second stage of the disease, when the joint has not yet lost its function.
2. Arthrodesis is a traditional surgical operation. It is performed with a significant violation of limb function, its looseness, common dislocations, and pain. The ligament is removed, the bones of the lower leg are joined to the bones of the foot. The lock becomes stationary and serves only as support.
3. Endoprosthetics is the replacement of a consumed and lost function of the ankle with an artificial function.

Characteristics of postoperative rehabilitation

All operations are performed in stationary conditions, after which experts recommend a complete rehabilitation. With sparing surgeries, rehabilitation is performed on an outpatient basis with early involvement in the course of therapeutic exercises with the exception of high loads on the joints. After endoprosthetics, the patient stays in the hospital for a week and then rehabilitation measures are performed on an outpatient basis. After two weeks, the sutures are removed and the patient can take a shower.

Dietary food

There is no specific diet for osteoarthritis. But to eliminate unnecessary stress on the ankle, it is necessary to maintain a normal body weight. A person should get the right healthy food, but the volume of high-calorie foods should be partially replaced by vegetables and fruits. The first and second low-fat dish, chicken, seafood, cottage cheese, cheese, dairy products are useful.

Traditional medicine

Using traditional medicine just for osteoarthritis will not help. 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; Pour 20 g of finely chopped grass overnight in a thermos with 500 ml of boiling water, drain in the morning and take half a glass 4 times a day for a month; analgesic, which restores cartilage tissue;
• for oral administration: take a ball of zombie with a diameter of 0. 5 cm in the morning, chewing it thoroughly, 30 minutes before eating for 10 days; Rest for 5 days, then repeat everything 3 more times; excellent stimulator of metabolic processes;
• Honey massage: apply warm liquid honey to the ankle before going to bed and rub lightly, massaging the tissues, for 5 minutes; then wrap the leg with a warm scarf and leave until morning; restores blood circulation and metabolism in cartilage tissue.

Access to treatment in clinics

Clinic doctors have developed their own approach to treating diseases such as osteoarthritis of the ankle and foot. During the initial appointment, a thorough examination of the patient is performed, the doctor carefully listens to his complaints and medical history, after which he prescribes additional laboratory and instrumental studies, including MRI. Only after this the doctor makes the final diagnosis, prescribes and agrees with the patient on the complex treatment. It consists of:

• Modern schemes of drug and non-drug treatment of osteoarthritis - drugs, physiotherapy, exercise therapy and massage, methods of fixation of the ankle;
• Traditional methods of oriental therapy - acupuncture, moxibustion, acupressure, various methods of kinesiotherapy, including taping.

These are not all methods used in clinics. Doctors are able to combine Western and Eastern methods, significantly accelerating the improvement of the patient's condition. Patients get rid of pain quickly, their quality of life improves significantly.

Combining proven Eastern techniques and innovative methods of western medicine.

Prevention of osteoarthritis of the foot

To reduce the risk of disease progression, the following recommendations should be followed:

• activity, exercise therapy exercises, swimming should become part of your life;
• high physical activity and any traumatic factor should be excluded; walking should be combined with rest, if the feet hurt during work, then it is worth changing it;
• injuries, especially in winter on ice, should be ruled out thinking about the modes of movement and the shoes used;
• rational food is needed to restore metabolism, but overweight is an extra burden on the ankle, get rid of it;
• preventive treatment courses are a guarantee of painless life.

Frequently asked questions about the disease

1. Which doctor should I contact for for osteoarthritis of the ankle and osteoarthritis of the foot?

   Tek orthopedist-traumatologist. But if the disease develops against the background of some kind of rheumatic process, then to a rheumatologist.

2. What predictions do doctors usually make?

   It is possible to stop the degenerative process and improve the quality of life at any stage, but it is best to do this early in the disease, do not wait for complications to appear.

3. Can osteoarthritis of the ankle develop in children?

   Maybe after an injury or against the background of a congenital pathology.

4. What are the consequences of the disease?

   Untreated osteoarthritis leads to disability. If you start treatment on time, it is quite possible to maintain limb function. Treatment in the later stages will relieve the pain and improve the quality of life.

5. Are Sports Injuries A Cause Of Ankle Osteoarthritis?

   Yes, sports injuries are one of the leading causes of this disease.

6. Is it possible to do ankle taping with osteoarthritis?

   It is possible, but it must be done by a specialist.

Ankle osteoarthritis is almost always the result of macro- or microtrauma. At first it proceeds slowly and invisibly. Therefore, timely treatment and rehabilitation after injuries is so important, as well as contacting a doctor at the first signs of ankle disease.