In recent years, experts around the world have noticed an increase in degenerative-dystrophic processes in the ankle, gradually leading to disability. Osteoarthritis of the ankle joint often develops as a result of serious injuries or permanent microtraumas 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.
Ankle osteoarthritis - what is it
The ankle is a complex, block-shaped joint formed by the lower (distal) ends of the tibia and fibula of the 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 talofibular and calcaneofibular ligaments. Function: flexion and extension of the foot. The ankle is functionally connected with the foot, it has ligaments and muscle tendons common with the joints of the foot.
Arthrosis of the ankle joint is a degenerative-dystrophic disease that begins with thinning and destruction of articular cartilage, reducing its depreciating properties, followed by the inclusion of all other joint tissues in the pathological process. The disease gradually leads to complete wear and tear of the joint and disability. The ICD-10 code for osteoarthritis of the ankle joint is M19.
The disease is less common than a similar knee injury and is usually the result of serious injury or long-term injuries as a result of any activity.
Causes of ankle osteoarthritis
Specialists have studied in detail the reasons for the development of arthrosis of the ankle joint and arthrosis of the foot. This one:
- 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 - they are ballerinas, dancers, professional athletes;
- increased load on legs with excessive body weight;
- inadequate load distribution when wearing shoes with high heels;
- metabolic disorders that negatively affect the metabolism of cartilage tissue - diabetes mellitus, obesity, gout, etc. ;
- hormonal changes, including those related to age;
- transferred severe acute purulent arthritis;
- long-term chronic arthritis of any origin;
- Osteochondrosis of the lumbar spine and intervertebral hernia, causing violation of spinal roots and weakening of leg and foot muscles, leading to joint instability and injuries.
Mechanism of disease development (pathogenesis)
Under the influence of various reasons, blood circulation in the joint region is disturbed, which leads to a decrease in the volume of synovial fluid that feeds the cartilaginous tissue. Due to the lack of oxygen and nutrients, the cartilage becomes thinner, cracks and erosions appear in it. This leads to injuries to the subcartilaginous layer of the bone. It thickens (sclerosing) and grows along the edges of joint surfaces. These growths are called osteophytes. They compress soft tissue, blood vessels and nerves, causing pain and further interrupting blood circulation.
Due to circulatory disorders and high tension, muscles suffer, they are weakened, which leads to joint instability and frequent dislocations. Arthrosis of the foot develops, small tarsal joints, metatarsal-tarsal, metatarsophalangeal and interphalangeal joints are affected.
Gradually, connective tissue grows into the joints, tightly binding the joint surfaces and disrupting joint function. Complete loss of ankle function is associated with fusion of the articulating bony joints. Osteoarthritis of the foot also develops gradually.
Symptoms of Ankle Osteoarthritis
Ankle osteoarthritis proceeds slowly and imperceptibly at first. But the symptoms appear and gradually increase, signaling some kind of violation in the lower limb.
first signs
The first symptom of osteoarthritis of the ankle is pain during high loads, for example, during a long walk, dancing, playing soccer or volleyball, etc. This pain passes quickly, so the person does not pay attention right away, attributing it to muscle fatigue. The pain can be either symmetrical in both joints (with high loads and microtraumas) or unilateral (after a major injury).
Then there is a feeling of stiffness in the morning or after a long stay in an immobile state. The ankles are stiff for a while, making movement difficult. In the early stages, it lasts for a few minutes and passes after a slow pace. This symptom should already alert and become a reason to go to the doctor.
Evident symptoms
Gradually, the pain after exertion intensifies and lasts longer. The leg can hurt all day. Night pains come together, usually appear in the second half of the night and are sometimes accompanied by painful muscle cramps. The periods of rigidity after immobility are also prolonged.
Due to the intense pain, a person starts limping while walking, tries to reduce the pain in the foot by stretching or pressing on 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. The inflammation is non-infectious in nature, develops from mechanical irritation, and resolves on its own without treatment. But at the same time, the exacerbation of synovitis activates the progression of the degenerative-dystrophic joint process.
dangerous symptoms
Constant pain, aggravated by physical exertion, instability, joint laxity, 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 the overgrowth of osteophytes. Osteoarthritis of the ankle (ankle) leads to its thickening. Movements in the foot are initially slightly limited and then the ankle becomes immobile or vice versa, loose, unstable. But even at this stage, the patient can be helped by simply contacting the clinic. Symptoms of arthrosis of the foot appear: pain in the foot, violation of its flexion and depreciation. The development of osteoarthritis of the big toe is accompanied by pain and deformity of the foot in the form of bulging and bending of the big toe outwards.
What is dangerous ankle osteoarthritis
The danger is that the disease at first develops imperceptibly and often the patient goes to the doctor, already in an advanced stage.
Any location and form of osteoarthritis has serious complications, so you should not delay treatment.
Classification
Ankle osteoarthritis can be primary, when the cause of its development is not established, and secondary, with a known cause. Depending on the cause of development, the disease may have its own distinctive features.
Post-traumatic osteoarthritis 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. Normally, 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 about it, a slight growing pain appears. This type of injury is dangerous because the patient goes to the doctor already in a state of abandonment. Serious injuries are better treated, their consequences appear more quickly and the patient seeks medical help sooner.
Long-term mild microtraumas to both ankles are typical of professional dancers, athletes, and people whose profession is associated with prolonged standing. There are symmetrical pains in the ankles during physical exertion. They are often mistaken for muscle aches with fatigue, so it's also too late to see a doctor.
Ankle osteoarthritis 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 ones (arthritis-arthritis). This accelerates the ankle destruction process. With an exacerbation of inflammation, the joints swell, the skin over them turns red, the pain becomes very intense, especially at night. When inflammation disappears, metabolic disorders 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 from acute purulent arthritis. The purulent process destroys joint tissues, and after recovery, connective tissue forms in its place, which disrupts limb function.
Osteoarthritis can also form after infectious arthritis - tuberculosis, gonorrhea, etc. Disease progression is associated with the main infectious process and the nature of the destruction. If the infection persists, joint destruction will progress.
Metabolic
It develops with a long course of gout. Often the first toe is affected. Other small joints in the foot and ankle are less commonly affected. As gout attacks continue, it is difficult to determine externally when the degenerative-dystrophic process occurs. You can only see it on an x-ray. In any case, the patient should be seen regularly by a rheumatologist and examined periodically.
Deforming arthrosis of the ankle joint
All types of osteoarthritis deform over time. Bone deformities indicate an advanced stage of the disease, when the cartilage is already collapsed and the constant mechanical impact on the bone tissue contributes to its growth along the edges of the joint surface. This is how the osteophytes that change the joint shape are formed.
Osteoarthritis of the ankle joint
There are several classifications, one of which distinguishes three clinical and radiological phases of osteoarthritis:
- Early. Some pain after standing or walking for a long time, some stiffness in the morning. All this quickly disappears without any help. Radiograph: Normal or mild narrowing of the joint space.
- progressive. Pain after physical exertion is stronger and longer. Stiffness increases, a crisis appears in the joints during movement. Sometimes the joint swells, reddens and hurts a lot - a sign of synovitis. Radiography shows significant narrowing of the joint space, thickening of subcartilaginous bone tissue (osteosclerosis), and proliferation of osteophytes.
- Final. The pain syndrome intensifies, becomes permanent. Because of the pain, the person limps, bends the feet, uses a cane or crutches. Limb function is impaired, osteoarthritis of the foot and thumb develops. The complete absence of flexo-extensor movements is rare, usually in the context of arthrosis-arthritis. On radiography: no joint space, osteosclerosis, large osteophytes deforming the joint.
Possible complications
If the disease is left untreated and everything is allowed to run its course, the following complications are possible:
- persistent joint dysfunction and disability;
- intense, incessant pain in the ankle and feet, both after exertion and without exertion;
- ankle instability with development of habitual dislocations and subluxations;
- damage to the foot and thumb will come together which will further aggravate the patient's condition.
Diagnosis of osteoarthritis of the ankle
Before prescribing treatment, the doctor performs an examination of the patient, including:
- interview and medical examination;
- additional research methods: laboratory tests (signs of inflammation and metabolic disorders are detected), instrumental studies (two-view radiograph of the joint, magnetic resonance imaging and computed tomography - early changes in bone structures and soft tissues are detected), diagnostic arthroscopy (the surface internal joint is examined).
Treatment of osteoarthritis 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 ankle joint osteoarthritis
Medications are prescribed that have a symptomatic effect (eliminates the symptoms of the disease) and pathogenic (suppresses the mechanism of the development of the disease).
Anti-inflammatories and analgesics
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 the synovitis has worsened):
- injection;
- rectal suppositories;
- oral pills;
- skin patch.
muscle relaxants
The muscles that surround the diseased joint and carry out its movement are in constant tension, which leads to its atrophy and increases the pain. To eliminate muscle spasms, drugs from the muscle relaxant group are prescribed.
chondroprotectors
Medications from the group of chondroprotectors contain glucosamine or chondroitin and sometimes both. They protect cartilage cells from destruction and promote their restoration. They are prescribed in the form of injections, pills and external agents (creams and ointments).
Hyaluronic acid preparations for osteoarthritis of the ankle joint
To improve the damping capacity of synovial fluid and prevent further damage to cartilage and bone tissues, hyaluronic acid is injected into the joint cavity. This results in pain relief and improved joint mobility.
Anti-arthritis gels and ointments for osteoarthritis of the ankle joint
External means can be used at home. Ointments for osteoarthritis of the ankle joint:
- NSAID gels are suitable for relieving pain and inflammation;
- to restore cartilage - chondroitin-based gel and ointment.
non-drug therapy
The main methods of treating ankle osteoarthritis are non-medicated. They are therapeutic exercises, massage, physiotherapy, use of orthopedic devices.
Physiotherapy
To alleviate the patient's condition and restore joint function, name:
- electrophoresis with medicinal substances;
- laser therapy;
- magnetotherapy;
- heating procedures - paraffin, ozocerite, in resort conditions - mud applications.
Massage for ankle joint osteoarthritis
Massage courses improve blood circulation, which leads to the activation of metabolism, restoration of joint 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, which is necessary to maintain the limb in the desired position.
Exercises and exercise therapy for osteoarthritis of the ankle joint
Therapeutic gymnastics is a panacea for osteoarthritis. Motor activity is very important, in addition to exercise therapy, swimming is helpful. Systematic implementation of the exercises selected by the doctor makes it possible to largely restore limb function even with advanced disease.
An approximate set of exercises (but before starting their implementation, you need to 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. Fixes the leg in the correct anatomical position, relieves muscle tension, improves blood circulation. The use of orthosis is prescribed by a doctor, who also selects the most suitable model.
Ankle fixation can also be performed with adhesive tape: with special adhesive tapes, the ankle is gently fixed in the desired position.
Surgical intervention
Operation 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 carried out in a traditional and smooth way:
- Therapeutic arthroscopy (sparing operations):
- cleaning the joint 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 is performed (mosaic arthroplasty); chondroplasty is effective in the 2nd stage of the disease, when the joint has not yet lost its function.
- Arthrodesis is a traditional surgical operation. It is performed with a significant violation of the function of the limb, its laxity, habitual dislocations and pain. The joint is removed, the leg bones are fused with the foot bones. The ankle is immobile and serves only as support.
- The endoprosthesis 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 complete rehabilitation. With sparing operations, rehabilitation is performed on an outpatient basis with early inclusion in the course of therapeutic exercises, with the exception of high loads on the joint. After the endoprosthesis, the patient remains 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 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 adequate healthy nutrition, but the volume of high-calorie foods should be partially replaced by vegetables and fruits. Low-fat first and second courses, chicken, sea fish, 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: wild rosemary infusion; Pour 20 g of chopped grass overnight into a thermos with 500 ml of boiling water, strain in the morning and drink half a glass 4 times a day for a month; analgesic, restoring cartilage tissue;
- for oral administration: take a 0. 5 cm diameter mummy ball in the morning, chewing well, 30 minutes before meals for 10 days; break 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 it lightly, massaging the tissues, for 5 minutes; then wrap the leg in a warm shawl and leave until morning; restores blood circulation and metabolism in cartilage tissue.
Approach to treatment in clinics
Clinicians have developed their own approach to treating conditions such as osteoarthritis of the ankle and foot. During the initial consultation, 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 the complex treatment. This consists of:
- modern drug and non-drug treatment regimens for osteoarthritis - drugs, physical therapy, exercise and massage therapy, ankle fixation methods;
- traditional oriental therapy methods - acupuncture, moxibustion, acupressure, various kinesiotherapy methods including bandage.
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.
It combines proven techniques from the East and innovative methods from 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 factors must be excluded; walking should be combined with rest, if the legs are injured during work, it is worth changing it;
- injuries, especially in winter on ice, should be ruled out thinking about the forms of movement and the shoes used;
- rational nutrition is necessary to restore metabolism, but excess weight 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 osteoarthritis 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 early in the disease, not wait for complications to appear.
- Can ankle osteoarthritis develop in children?
Perhaps after an injury or against the background of a congenital pathology.
- What are the consequences of the disease?
Untreated osteoarthritis leads to disability. If you start treating in time, it is quite possible to preserve limb function. 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 bandage an ankle with osteoarthritis?
It is possible, but it must be done by an expert.
Osteoarthritis 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 are just as important, as is contacting a doctor at the first signs of ankle disease.