Arthrosis of the ankle joint — degenerative-dystrophic damage to cartilage tissue. But as the disease progresses, the articular surfaces of the bones are involved in the process, it is more correct to call it osteoarthritis. In foreign literature, when describing this disease, the term osteoarthritis is used, which means not only degenerative changes, but also inflammation on this background.
Osteoarthritis — This is a chronic, progressive joint disease in which cartilage, articular surfaces of bones, capsule and periarticular tissue are destroyed. This leads to pain and reduced joint mobility. The ankle rarely experiences osteoarthritis, unlike the knee. The disease occurs more often in women over the age of 50 and in athletes who have injured their feet. For arthrosis of the ankle joint, the treatment depends on the manifestations of the disease and is selected individually by an orthopedic traumatologist. Doctors use methods that have proven their effectiveness and safety, and practice a multidisciplinary approach in treating problems and preventing the progression of joint pathology.
This article is advisory in nature. Treatment is prescribed by a specialist after consultation.
As the disease develops
The ankle joint consists of three bones: tibia, fibula and talus, covered by a joint capsule and strengthened by ligaments. Thanks to the work of the muscles, the foot bends and stretches. Normally, the articular surfaces are smooth and slide easily relative to each other during movement. Covered with dense, elastic cartilage, its main function — bone protection and load absorption. The joint cavity contains synovial fluid. It has the role of intra-articular lubrication, preventing friction of joint elements and their abrasion during movement.
But as a result of injury or natural aging of the joint, the joint surfaces become rough, and the cartilage tissue loses its smoothness and elasticity. When the cartilage is damaged and as the degenerative changes progress, the bones begin to come into contact with each other when moving the joint, which is accompanied by pain.
In attempts to "defend" itself to compensate for further damage to the joint and surrounding tissues, osteophytes are formed — growths along the edges of the articular surfaces of the bones. As a result, joint mobility is partially or even completely limited.
Depending on the underlying cause, the following types of osteoarthritis are distinguished:
- Primary or idiopathic osteoarthritis. In this case, we are talking about degenerative-dystrophic changes in the joint
- Secondary is associated with exposure to a specific causative factor, usually a previous joint injury. And this form is most often diagnosed
Predisposing factors
The main predisposing factors for the development of ankle arthrosis:
- intra- and peri-articular injuries, such as bone fractures, tears and ligament ruptures
- ankle surgery
- inflammatory joint lesions in the past
- intensive loads: professional sports, ballet, long walking, work associated with long periods "on your feet"
- sedentary lifestyle
- wearing high heels for a long time
- excess weight
- hereditary collagenopathies that lead to impaired collagen synthesis
- chronic injuries of joint structures due to excessive loads
- metabolic disorders: diabetes, gout
- estrogen deficiency in postmenopausal women
- rheumatic diseases
- foot deformities, such as flat feet
- degenerative-dystrophic changes in the spine, complicated by the formation of an intervertebral hernia, which is accompanied by compression of the nerve root
Arthrosis of the ankle joint: symptoms
The main sign of arthrosis — Pain is what makes you seek medical help. At the beginning of the development of the disease, the pain is disturbing only after prolonged exercise and decreases with rest.
Depending on the stage of pathological changes in the joint, the pain becomes more intense and lasts at rest and even at night. Other symptoms also appear.
There are three stages of the disease:
- The first stage is characterized by mild swelling, redness of the skin of the joint area, pain in the afternoon or after intense exercise. Unpleasant sensations are localized along the front surface of the foot, along the joint line and move to the lateral surfaces of the ankle joint. A foot x-ray may not yet show any changes.
- In the second stage, the pain becomes constant, there is a creak when moving the joint, mobility is limited, and the joint is "stuck". During the X-ray examination, growths along the edges of the joint surfaces of the bones: tibia, ankles and talus, as well as a narrowing of the joint space, are visible.
- In the third phase, joint deformation occurs, which is why only low-amplitude rocking movements are possible. An X-ray reveals massive bony growths, the joint space is sharply narrowed or even absent. Due to the instability of the joint, patients often twist their leg, which only worsens the situation due to sprains, torn ligaments and worsening of the general condition.
Pain in arthrosis of the ankle joint has characteristic features:
- The maximum expressed at the beginning of the movement — the so-called initial pain
- It increases significantly with load, especially when running, jumping
- It often appears in the evening, at night or immediately after waking up
Due to the pain, there is limited mobility of the foot, as well as jamming in the joint because the cartilage is destroyed.
Symptoms manifest in waves: exacerbations alternate with remissions. With worsening, the symptoms are more pronounced. During remission, symptoms gradually subside and may even disappear completely.
Which doctor should I contact?
If you experience pain and stiffness in the movements of the ankle joint, you should contact an orthopedic traumatologist. If another cause of joint discomfort is found, a consultation with a neurologist, rheumatologist or endocrinologist may be necessary.
Diagnostics
In order to make a diagnosis, the doctor clarifies the complaints, specifies how long the pain exists, which contributes to its occurrence and intensification. The specialist collects data on existing diseases, injuries and lifestyle characteristics, performs an examination, assesses the range of motion in the joint and performs diagnostic tests.
Already based on the information obtained, it is possible to assume a diagnosis, but in order to confirm and develop a competent treatment plan, additional examination methods are needed, which may include:
- X-ray of the ankle joint, which is of primary importance in establishing a diagnosis and determining the stage of disease development. The images show narrowing of the joint space, osteophytes on the edges of the articular surfaces of the bones, cysts and signs of bone thinning that are located under the cartilage.
- A CT scan of the joint reflects the picture in more detail. The doctor can assess the condition of the patient's bone structures and cartilage tissue in detail
- MRI is used to study cartilage and soft tissues
- Ultrasound of the joint to assess the state of soft joint structures
Treatment of arthrosis
Treatment of the pathology is long-term and is carried out under the supervision of an orthopedic traumatologist on an outpatient basis. How to cure leg arthrosis depends on the stage of damage and existing complications.
The main goals of treating the disease in a modern clinic are alleviating pain in the legs, improving the quality of life of patients and slowing down the progression of arthrosis. To do this, the doctor develops a set of therapeutic and preventive measures, medical and non-medical, and also adjusts the patient's lifestyle.
Correction of lifestyle and diet
Sufficient physical activity and correction of diet will help to suppress degenerative changes. After the examination, the clinic's doctors can give recommendations on weight loss, as well as optimizing the load on the legs.
Drug treatment
Medicines are selected individually, based on examination data, symptoms and accompanying diseases. The patient may be prescribed:
- Analgesics. Most often, these are non-steroidal anti-inflammatory drugs in the form of tablets, gels, injections to relieve pain and inflammation
- Antidepressants and anticonvulsants for prolonged, severe pain that is difficult to treat
Exercise therapy
Specially selected exercises help maintain the range of motion in the joint, reduce pain and curb the progression of degenerative changes. The patient first performs the recommended exercises under the supervision of a specialist, and then — alone, at home.
Massage
Massage of the lower limb normalizes the nutrition of joint tissues. It is prescribed outside the acute phase. During the session, the specialist performs passive movements in the joint, which prevents muscle shortening and stiffness of the joint.
Assistive devices
Special orthoses, canes and walkers can be recommended to relieve stress and stabilize the ankle joint.
Operation
It is used only in cases of severe destruction of articular cartilage and limited mobility of the joint. After the operation, a long period of rehabilitation and conservative treatment follows. Endoprosthetics or arthroplasty in the later stages of the development of ankle arthrosis — practically the only chance to avoid disability and maintain joint mobility.
Why is ankle arthrosis dangerous?
The changes that have already occurred in the joint are irreversible. Therefore, the treatment is aimed at slowing down the pathological process in order to preserve the patient's working ability and quality of life. Such goals can be achieved only with timely treatment and strict adherence to the doctor's recommendations.
As arthrosis develops, pronounced deformation of the joint is formed. The range of motion decreases sharply, as a result, the ability to support the foot becomes difficult; walking without crutches or a cane is almost impossible.
Chronic, constant joint pain leads to anxiety and depressive disorders.
Prevention
Prevention of arthrosis includes the following measures:
- Avoid traumatic activities. For example, jumping from great heights, running
- Avoid injury
- Be careful in icy conditions, wear non-slip shoes
- Control your body weight
- Normalizing body weight will help reduce stress on the ankle joint
- Stay moderately active
- An inactive lifestyle is dangerous and leads to complications, as well as excessive overload and microtrauma
- Keep your joints healthy
- Consult a doctor immediately and treat musculoskeletal diseases
Main points from the article:
- The prevalence of degenerative-dystrophic diseases of the foot joints is 87%
- Occupational hazards, everyday habits and previous injuries can lead to ankle arthrosis.
- A common symptom of arthrosis — pain, which is accompanied by a creaking sound when moving, local swelling, and later limited mobility of the foot
- Treatment of arthrosis of the ankle joint is often conservative and includes both medical and non-medical methods.
- The progression of ankle arthrosis leads to disability and complete loss of foot function