Osteoarthritis of the ankle joint is a chronic disease that affects the articular cartilage and subsequently other structures of the joint (capsule, synovial membrane, bones, ligaments). It has a degenerative-dystrophic character. It manifests as pain and limitation of movement, followed by progressive deterioration of support and walking functions. The diagnosis is made based on symptoms, examination and x-ray. Treatment is usually conservative, using anti-inflammatories, chondroprotectors and glucocorticoids, and prescribing exercises and physiotherapy. In severe cases, sanitary arthroscopy, arthrodesis or endoprosthesis is performed.
General information
Arthrosis of the ankle joint is a disease in which the articular cartilage and surrounding tissues are gradually destroyed. The disease is based on degenerative-dystrophic processes, inflammation in the joint is secondary. Osteoarthritis has a chronic undulatory course with alternating remissions and exacerbations and progresses gradually. Women and men suffer with the same frequency. The probability of development increases dramatically with age. At the same time, experts point out that the disease "is getting younger": currently one in three cases of ankle osteoarthritis is detected in people under 45 years of age.
Causes
Primary osteoarthritis occurs for no apparent reason. Secondary damage to the ankle joint develops under the influence of some unfavorable factors. In both cases, the basis is a violation of metabolic processes in cartilaginous tissue. The main causes and predisposing factors for the formation of secondary osteoarthritis of the ankle joint are:
- significant intra- and peri-articular injuries (talar fractures, ankle fractures, ligament tears and ruptures);
- ankle surgery;
- excessive load - too intense sports, long walks or constant standing due to working conditions;
- wearing shoes with heels, excess weight, constant microtrauma;
- diseases and conditions associated with metabolic disorders (diabetes mellitus, gout, pseudogout, estrogen deficiency in postmenopause);
- rheumatic diseases (SLE, rheumatoid arthritis);
- osteochondrosis of the lumbar spine, intervertebral hernia and other conditions that are accompanied by pinching of nerves and disruption of the muscular system of the foot and leg.
Less commonly, the cause of osteoarthritis is nonspecific purulent arthritis, arthritis due to specific infections (tuberculosis, syphilis), and congenital developmental anomalies. Unfavorable environmental conditions and hereditary predisposition play a certain role in the development of osteoarthritis.
Pathogenesis
Normally, articular surfaces are smooth, elastic, slide smoothly against each other during movements and provide effective shock absorption under load. As a result of mechanical damage (trauma) or metabolic disorders, cartilage loses its softness, becomes rough and inelastic. Cartilages "rub" during movements and damage each other, leading to worsening pathological changes.
Due to insufficient depreciation, excess load is transferred to the underlying bone structure and degenerative-dystrophic disorders also develop on it: the bone deforms and grows along the edges of the joint area. Due to secondary trauma and disruption of the normal biomechanics of the joint, not only the cartilage and bone suffer, but also the surrounding tissues.
The joint capsule and synovial membrane thicken and foci of fibrous degeneration form in the periarticular ligaments and muscles. It decreases the joint's ability to participate in movements and bear loads. Instability occurs and the pain progresses. In severe cases, the articular surfaces are destroyed, the supporting function of the limb is impaired, and movements become impossible.
Symptoms
Initially, after significant loading, rapid fatigue and mild pain in the ankle joint are detected. Subsequently, the pain syndrome becomes more intense, its nature and the time of appearance change. The distinctive characteristics of pain with osteoarthritis are:
- Initial pain. They appear after a state of rest, and then disappear progressively with movement.
- Load dependence. There is increased pain during exercise (standing, walking) and rapid fatigue of the joint.
- Night pain. It usually appears in the morning.
The condition changes in waves, during exacerbations the symptoms are more pronounced, in the remission phase they first disappear and then become less intense. There is a gradual progression of symptoms over several years or decades. Along with pain, the following manifestations are determined:
- When moving, creaking, squeaking or clicking may occur.
- During an exacerbation, the periarticular area sometimes becomes swollen and red.
- Due to the instability of the joint, the patient often twists the leg, causing sprains and tears in the ligaments.
- Stiffness and limitation of movement are noted.
Complications
During an exacerbation, reactive synovitis may occur, accompanied by fluid accumulation in the joint. At later stages, a pronounced deformation is revealed. Movements are very limited and contractures develop. Support becomes difficult; When moving, patients are forced to use crutches or a cane. There is a decrease or loss of the ability to work.
Diagnosis
The diagnosis of osteoarthritis of the ankle joint is made by an orthopedic doctor based on an examination, data from external examinations and the results of additional studies. When examined in the initial stages, there may be no changes, but later deformities, limitation of movements and pain on palpation are revealed. Great importance is given to visualization techniques:
- X-ray of the ankle joint. It plays a decisive role in making the diagnosis and determining the degree of osteoarthritis. Pathology is indicated by narrowing of the joint space, proliferation of the edges of the articular surfaces (osteophytes). At a later stage, cystic formations and osteosclerosis of the subchondral zone (located under the cartilage) of the bone are detected.
- Tomographic studies. Used when indicated. In difficult cases, for a more accurate assessment of the state of bone structures, the patient is additionally sent for a CT scan and, to examine soft tissues, for an MRI of the ankle joint.
Laboratory tests do not change. If necessary, to establish the cause of osteoarthritis and differential diagnosis with other diseases, consultations with related specialists are prescribed: neurologist, rheumatologist, endocrinologist.
Treatment of ankle osteoarthritis.
The treatment of the pathology is long-term and complex. Patients are usually seen by an orthopedic surgeon on an outpatient basis. During the period of exacerbation, hospitalization in the traumatology and orthopedics department is possible. The most important role in slowing down the progression of osteoarthritis is played by lifestyle and the correct mode of physical activity, therefore, recommendations are given to the patient to lose weight and optimize the load on the leg.
drug therapy
It is selected individually, taking into account the stage of osteoarthritis, the severity of symptoms and concomitant diseases. Includes general and local agents. The following groups of drugs are used:
- General NSAIDs. Tablets are usually used. Medications have a negative effect on the gastric mucosa, therefore, in case of gastrointestinal diseases, "mild" medications are preferable.
- local NSAIDs. Recommended both during the exacerbation period and in the remission phase. It may be prescribed as an alternative if side effects from the tablets occur. Available in the form of ointments and gels.
- Chondroprotectors. Substances that help normalize metabolic processes in cartilage tissue. They are used in the form of creams, gels and preparations for intra-articular administration. Use medications containing glucosamine and collagen hydrolyzate.
- Hormonal agents. In cases of severe pain that cannot be relieved by medication, intra-articular corticosteroids are administered no more than 4 times a year.
- Metabolic stimulants. To improve local blood circulation and activate tissue metabolism, nicotinic acid is prescribed.
Physiotherapy treatment
The patient is prescribed a physiotherapy complex, developed taking into account the manifestations and stage of the disease. The patient is referred to physical therapy. Massage and UHF are used in the treatment of osteoarthritis. Additionally, in the treatment of pathology, the following are used:
- laser therapy;
- thermal procedures;
- Medicinal electrophoresis and ultraphonophoresis.
Surgery
Indicated in the later stages of the disease, when conservative therapy is ineffective, severe pain syndrome, deterioration in the quality of life of patients or limited ability to work. The operations are carried out in a hospital setting and are open and minimally invasive:
- Arthroscopic interventions. If there is significant cartilage destruction, arthroscopic chondroplasty is performed. Remedial arthroscopy (removal of formations that impede movement) is usually performed for severe pain in stage 2 osteoarthritis. The effect lasts for several years.
- Arthrodesis of the ankle joint. It is performed in case of significant destruction of the articular surfaces, it involves the removal of the joint and the "fusion" of the bones of the foot and lower leg. Provides restoration of the supporting function of the limb in case of loss of joint mobility.
- Ankle joint endoprosthesis. Made for advanced osteoarthritis. It involves removing the destroyed articular surfaces of bones and replacing them with plastic, ceramic or metal prostheses. Movements are completely restored, the useful life of the prosthesis is 20 to 25 years.
Forecast
Changes in the joint are irreversible, but the slow progression of osteoarthritis, timely start of treatment and compliance with the recommendations of an orthopedic traumatologist in most cases allow maintaining working capacity and a high quality of life during decades after appearance. of the first symptoms. With a rapid increase in pathological changes, endoprosthesis makes it possible to avoid disability.
Prevention
Preventive measures include reducing the level of injuries, especially in winter, during icy periods. If you are obese, you need to take measures to reduce body weight to reduce the load on the joint. It is necessary to maintain a moderate physical activity regimen, avoid overloads and microtrauma, and quickly treat diseases that can trigger the development of osteoarthritis of the ankle joint.