In recent years, experts around the world have noted an increase in degenerative-dystrophic processes in the ankle, gradually leading to disability. Arthrosis of the ankle joint often develops as a result of serious injuries or permanent microtrauma in athletes, professional dancers, circus performers. How to notice the signs of this disease in a timely manner and stop its progression, as well as how it is treated, you will learn from this article.
Arthrosis of the ankle - what is it
The ankle is a complex block joint formed by the lower (distal) ends of the tibia and fibula of the lower leg, forming the inner and outer ankles (ankles), as well as the talus of the foot. From the inside, it is strengthened by the deltoid ligament, from the outside - by the anterior and posterior talo-peroneal and calcaneal-peroneal ligaments. Function: flexion and extension of the foot. The ankle is functionally connected with the foot, has common ligaments and muscle tendons with the joints of the foot.
Arthrosis of the ankle joint is a degenerative-dystrophic disease that begins with thinning and destruction of the articular cartilage, reducing its depreciation properties, followed by the inclusion of all other articular tissues in the pathological process. The disease gradually leads to complete wear and tear of the joint and disability. The code for arthrosis of the ankle joint ICD-10 is M19.
The disease is less common than a similar knee lesion and is usually the result of serious injuries or long-term injury as a result of any activity.
Causes of osteoarthritis of the ankle
Specialists have studied in detail the reasons for the development of arthrosis of the ankle joint and arthrosis of the foot. This:
- injuries - intra-articular fractures of the joints, fractures of the ankles, complete and incomplete ruptures of ligaments and tendons;
- microtrauma due to any professional activity - these are ballerinas, dancers, professional athletes;
- increased load on the legs with excessive body weight;
- improper load distribution when wearing shoes with high heels;
- metabolic disorders that have a negative effect on the metabolism in cartilage tissue - diabetes mellitus, obesity, gout, etc . ;
- hormonal, including age-related, shifts;
- transferred severe acute purulent arthritis;
- long-term chronic arthritis of any origin;
- osteochondrosis of the lumbar spine and intervertebral hernia, causing infringement of the spinal roots and weakening of the muscles of the lower leg and foot, leading to joint instability and 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 feeds cartilage tissue. Due to the lack of oxygen and nutrients, the cartilage becomes thinner, cracks and erosions appear on it. This leads to injury to the subcartilaginous layer of the bone. It thickens (sclerosing) and grows along the edges of the articular surfaces. These growths are called osteophytes. They compress soft tissues, blood vessels and nerves, causing pain and further disrupting blood circulation.
Due to circulatory disorders and high tension, the muscles suffer, they are weakened, which leads to joint instability and frequent dislocations. Arthrosis of the foot develops, small joints of the tarsus, metatarsal-tarsal, metatarsophalangeal and interphalangeal joints are affected.
Gradually, connective tissue grows in the joints, tightly binding the articular surfaces and violating the articular function. The complete loss of function of the ankle is associated with the fusion of the bone articular joints. Arthrosis of the foot also gradually develops.
Symptoms of osteoarthritis of the ankle
Arthrosis of the ankle proceeds slowly and imperceptibly at first. But symptoms gradually appear and increase, signaling some kind of violation in the lower limb.
First signs
The very first symptom of arthrosis of the ankle is pain during high loads, for example, during long walking, dancing, playing football or volleyball, etc. This pain passes quickly, so the person does not immediately pay attention to it, attributing it to muscle fatigue. Pain can be both symmetrical in both joints (with high loads and microtraumas), and unilateral (after a major injury).
Then there is a feeling of stiffness in the morning or after a long stay in a motionless state. The ankles become stiff for a while, making movement difficult. In the initial stages it lasts a few minutes and passes after slow pacing. This symptom should already alert and become a reason for going to the doctor.
Overt symptoms
Gradually, the pain after exertion intensifies, lasting longer. The leg can hurt all day. Night pains join, they usually appear in the second half of the night and are sometimes accompanied by painful muscle cramps. The periods of stiffness after immobility are also lengthened.
Due to severe pain, a person begins to limp while walking, tries to reduce pain in the foot by stretching or pressing it. Sometimes the ankle swells, the skin over it turns 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, exacerbation of synovitis activates the progression of the articular degenerative-dystrophic process.
Dangerous symptoms
Constant aching pain, aggravated by physical exertion, instability, looseness of the joint, a tendency to subluxations, dislocations and ligament injuries are dangerous symptoms that require a visit to a doctor. The ankle changes externally: it takes on a different shape due to overgrown osteophytes. Arthrosis of the ankle (ankle) leads to its thickening. Movements in the foot are initially slightly limited, and then the ankle becomes motionless or vice versa, loose, unstable. But even at this stage, the patient can be helped, you just need to contact the clinic. Symptoms of arthrosis of the foot appear: pain in the foot, violation of its flexion and depreciation. The development of arthrosis of the big toe is accompanied by pain and deformity of the foot in the form of bulging and bending the big toe outward.
What is dangerous arthrosis of the ankle
The danger is that the disease at first develops imperceptibly and very often the patient goes to the doctor, having already advanced stage.
Any localization and form of arthrosis has serious complications, so you should not delay treatment.
Classification
Arthrosis of the ankle can be primary, when the cause of its development is not established, 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 joint
The consequences of traumatic injury are the most common cause of the disease. Post-traumatic arthrosis of the ankle joint can develop after a major injury - ligament rupture, dislocation, intra-articular fracture. Usually one joint is injured, so post-traumatic arthrosis is one-sided. A small but untreated injury may not make itself felt at first. And only after a while, when a person has already forgotten about it, a slight growing soreness appears. This type of injury is dangerous because the patient goes to the doctor already in a neglected state. Serious injuries are treated better, their consequences appear faster and the patient seeks medical help not so late.
Inconspicuous long-term microtrauma of both ankles is typical for professional dancers, athletes and people whose profession is associated with a long stay on their feet. There are symmetrical pains in the ankles during physical exertion. They are usually mistaken for muscle pain with fatigue, so it can also be late to see a doctor.
Arthrosis of the ankle after arthritis
The causes of these arthrosis 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 destruction of the ankle. With an exacerbation of inflammation, the joints swell, the skin over them turns red, the pain becomes very severe, especially at night. When the inflammation subsides, metabolic disturbances predominate, while all processes develop very quickly. The disease requires constant monitoring and treatment by a rheumatologist.
Much less often, the degenerative-dystrophic process develops after suffering 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.
Arthrosis can also form after infectious arthritis - tuberculosis, gonorrhea, etc. The progression of the disease is associated with the main infectious process and the nature of the destruction. If the infection persists, joint destruction will progress.
Metabolic
Develops with a long course of gout. Very often the first toe is affected. Other small joints of the foot and ankle are less commonly affected. Since gout attacks continue, it is difficult to outwardly determine when the degenerative-dystrophic process occurs. You can only see it on an x-ray. In any case, the patient should be regularly observed by a rheumatologist and periodically examined.
Deforming arthrosis of the ankle joint
All types of arthrosis 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. This is how osteophytes are formed that change the articular shape.
Degrees of arthrosis of the ankle joint
There are several classifications, one of which distinguishes three clinical and radiological stages of arthrosis:
- Early. A little soreness after standing or walking for a long time, some stiffness in the morning. All this disappears quickly without any help. X-ray: normal or slight narrowing of the joint space.
- progressive. Pain after physical exertion is stronger and longer. Stiffness increases, a crunch appears in the joints during movement. Sometimes the joint swells, reddens and hurts a lot - a sign of synovitis. The x-ray shows a significant narrowing of the joint space, thickening of the subcartilaginous bone tissue (osteosclerosis), and proliferation of osteophytes.
- Final. The pain syndrome intensifies, becomes permanent. Because of the pain, a person limps, tucks his feet, uses a cane or crutches. The function of the limb is impaired, arthrosis of the foot and thumb develops. The complete absence of flexion-extensor movements is rare, usually against the background of arthrosis-arthritis. On x-ray: there is 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 dysfunction of the joint and disability;
- severe incessant pain in the ankle and feet, both after exertion and without it;
- instability of the ankle with the development of habitual dislocations and subluxations;
- damage to the foot and thumb will join, which will further aggravate the patient's condition.
Diagnosis of arthrosis of the ankle
Before prescribing treatment, the doctor conducts an examination of the patient, including:
- medical interview and examination;
- additional research methods: laboratory tests (signs of inflammation and metabolic disorders are detected), instrumental studies (radiography of the joint in two projections, computed and magnetic resonance imaging - early changes in bone structures and soft tissues are detected), diagnostic arthroscopy (the internal articular surface is examined).
Treatment of arthrosis of the ankle joint
After establishing the final diagnosis, the doctor selects an individual treatment complex for the patient, consisting of drug and non-drug methods.
Medical treatment of osteoarthritis of the ankle joint
Drugs are prescribed that have a symptomatic (eliminates the symptoms of the disease) and pathogenetic (suppresses the mechanism of the development of the disease) effect.
Anti-inflammatory and painkillers
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;
- skin patch.
Muscle relaxants
The muscles surrounding the diseased joint and carrying out its movement are in constant tension, which leads to their atrophy and increases pain. To eliminate muscle spasms, drugs from the group of muscle relaxants are prescribed.
Chondroprotectors
Medicines 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 arthrosis of the ankle joint
To improve the cushioning abilities of the synovial fluid and prevent further injury to the cartilaginous and bone tissues, hyaluronic acid is injected into the joint cavity. This results in pain relief and improved joint mobility.
Antiarthrosis gels and ointments for arthrosis of the ankle joint
External means can be used at home. Ointments for arthrosis of the ankle joint:
- 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 arthrosis of the ankle are non-drug. These are therapeutic exercises, massage, physiotherapy, wearing orthopedic devices.
Physiotherapy
To alleviate the patient's condition and restore joint function, appoint:
- electrophoresis with medicinal substances;
- laser therapy;
- magnetotherapy;
- warming procedures - paraffin, ozocerite, in the conditions of resorts - mud applications.
Massage for osteoarthritis of the ankle joint
Massage courses improve blood circulation, which leads to the activation of metabolism, the restoration of articular and extra-articular tissues. The positive effect of massage on the muscles is the elimination of spasm, which contributes to the flow of blood to the muscles, and the restoration of their strength, necessary to hold the limb in the desired position.
Exercises and exercise therapy for arthrosis of the ankle joint
Therapeutic gymnastics is a panacea for arthrosis. Motor activity is very important, in addition to exercise therapy, swimming is useful. The systematic implementation of the exercises selected by the doctor allows you to largely restore the function of the limb, even with an advanced disease.
An approximate set of exercises (but before you start its implementation, you need to consult your doctor):
Use of special orthopedic products
In order to prevent the progression of the disease, the doctor may prescribe the wearing of a special orthopedic device - an orthosis. It fixes the leg in the correct anatomical position, relieves muscle tension, improves blood circulation. Wearing an orthosis is prescribed by a doctor, who also selects the most suitable model.
Ankle fixation can also be carried out using taping: with special adhesive tapes, the ankle is gently fixed in the desired position.
Surgical intervention
The operation is recommended for severe pain that is not eliminated by conservative methods of treatment, as well as for significant dysfunction of the limb.
Types of surgical interventions
Operations can be carried out in traditional and gentle ways:
- Therapeutic arthroscopy (sparing operations):
- sanitation of the articular cavity - 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 - the damaged layer of cartilage is removed, which stimulates the growth of new cartilage cells (abrasive chondroplasty); in some cases, transplantation of sections of autocartilage taken from unloaded areas of the patient's knee joint (mosaic arthroplasty) is performed; chondroplasty is effective at the 2nd stage of the disease, when the joint has not yet lost its function.
- Arthrodesis is a traditional surgical operation. It is carried out with a significant violation of the function of the limb, its looseness, habitual dislocations and pain. The joint is removed, the bones of the lower leg are fused with the bones of the foot. The ankle becomes motionless and serves only as a support.
- Endoprosthetics is the replacement of a worn and lost function of the ankle with an artificial one.
Features of rehabilitation after surgery
All operations are carried out in stationary conditions, after which experts recommend a full rehabilitation. With sparing operations, rehabilitation is carried out on an outpatient basis with early inclusion in the course of therapeutic exercises with the exception of high loads on the joint. After endoprosthetics, the patient stays in the hospital for a week, and then rehabilitation measures are carried out on an outpatient basis. After two weeks, the stitches are removed and the patient can take a shower.
Diet food
There is no special diet for osteoarthritis. But to eliminate unnecessary stress on the ankle, it is necessary to maintain a normal body weight. A person should receive proper healthy nutrition, but the volume of high-calorie foods should be partially replaced with vegetables and fruits. Low-fat first and second courses, chicken, sea fish, cottage cheese, cheese, dairy products are useful.
Traditional medicine
The use of traditional medicine alone for arthrosis 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, strain in the morning and take half a glass 4 times a day for a month; analgesic, restoring cartilage tissue;
- for oral administration: take a mummy ball with a diameter of 0. 5 cm in the morning, chewing thoroughly, 30 minutes before meals for 10 days; break 5 days, then repeat everything 3 more times; excellent stimulant of metabolic processes;
- honey massage: apply warm liquid honey on the ankle before going to bed and rub lightly, massaging the tissues, for 5 minutes; then wrap the leg in a warm shawl and leave until the morning; restores blood circulation and metabolism in cartilaginous tissue.
Approach to treatment in clinics
Clinic doctors have developed their own approach to the treatment of diseases such as ankle and foot arthrosis. During the initial appointment, a thorough examination of the patient is carried out, the doctor carefully listens to his complaints and the history of the disease, after which he prescribes additional laboratory and instrumental studies, including MRI. Only after that the doctor establishes the final diagnosis, prescribes and agrees with the patient on complex treatment. It consists of:
- modern schemes of drug and non-drug treatment of arthrosis - drugs, physiotherapy, exercise therapy and massage, ankle fixation methods;
- 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 quickly get rid of pain, their quality of life improves significantly.
Combined proven techniques of the East and innovative methods of Western medicine.
Prevention of arthrosis 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 factors should be excluded; hiking should be combined with rest, if the legs are injured during work, then it is worth changing it;
- injuries, especially in winter on ice, should be ruled out by thinking over the ways of movement and the shoes used;
- rational nutrition is necessary to restore metabolism, but being overweight is an extra load on the ankle, get rid of it;
- preventive treatment courses are a guarantee of pain-free life.
Frequently asked questions about the disease
- Which doctor should I contact for osteoarthritis of the ankle joint and arthrosis of the foot?
To the orthopedist-traumatologist. But if the disease developed against the background of some kind of rheumatic process, then to a rheumatologist.
- What predictions do doctors usually give?
It is possible to stop the progression of the degenerative process and improve the quality of life at any stage, but it is best to do this at the beginning of the disease, do not wait for complications to appear.
- Can osteoarthritis of the ankle develop in children?
Maybe after an injury or on the background of a congenital pathology.
- What are the consequences of the disease?
Untreated arthrosis leads to disability. If you start treating on time, it is quite possible to preserve the function of the limb. Treatment in the later stages will relieve pain and improve quality of life.
- Are sports injuries a cause of ankle osteoarthritis?
Yes, sports injuries are one of the main causes of this disease.
- Is it possible to do ankle taping with arthrosis?
It is possible, but this should be done by a specialist.
Arthrosis of the ankle joint is almost always the result of macro- or microtrauma. It proceeds slowly and imperceptibly at first. Therefore, timely treatment and rehabilitation after injuries is so important, as well as contacting a doctor at the first signs of ankle disease.