Arthrosis of the ankle joint — degenerative-dystrophic damage of cartilage tissue. However, as the disease progresses, it is more correct to call it osteoarthritis, as the joint surfaces of the bones are involved in the process. When describing this disease in foreign literature, the term osteoarthritis is used, which indicates not only degenerative changes, but inflammation against this background.
Osteoarthritis — This is a chronic, progressive joint disease in which cartilage, articular surfaces of bones, capsule and periarticular tissues are destroyed. This causes pain and impaired joint mobility. Osteoarthritis is rare in the ankle, unlike the knee. The disease occurs more often in women over 50 years of age and in athletes with leg injuries. Treatment for arthrosis of the ankle joint 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 apply a multidisciplinary approach to treat the problem and prevent the development of joint pathology.
This article is advisory in nature. Treatment is prescribed by a specialist after consultation.
How the disease develops
The ankle joint consists of three bones: tibia, fibula and talus, covered by an articular capsule and strengthened by ligaments. Thanks to the work of the muscles, the leg bends and stretches. Normally, the joint surfaces are smooth and slide easily relative to each other during movements. Covered with dense, elastic cartilage, its main function is protection of bones and absorption of load. There is synovial fluid in the joint cavity. It acts as intra-articular lubrication, prevents friction and wear of joint elements during movements.
But as a result of joint damage or natural aging, joint surfaces become rough, cartilage tissue loses its smoothness and elasticity. When the cartilage is damaged and 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 "protect" and compensate for further damage to the joint and surrounding tissues, osteophytes are formed — growths along the edges of the articular surfaces of bones. As a result, the mobility of the joint is partially or even completely limited.
Depending on the root 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 arthrosis of the ankle joint:
- intra- and periarticular injuries such as bone fractures, lacerations and ligament tears
- ankle surgery
- inflammatory joint lesions in the past
- intense loads: professional sports, ballet, long walks, work related to staying "on your feet" for a long time
- sedentary lifestyle
- wearing high heels for a long time
- overweight
- hereditary collagenopathies that cause a violation of collagen synthesis
- chronic damage to 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 accompanied by compression of the nerve root
Ankle arthrosis: symptoms
The main symptom of arthrosis — Pain prompts you to seek help from a doctor. At the beginning of the development of the disease, the pain is uncomfortable only after prolonged exercise and decreases with rest.
Depending on the stage of pathological changes in the joint, the pain becomes stronger and continues at rest and even at night. Other symptoms occur.
There are three stages of the disease:
- The first stage is characterized by slight 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 pass to the lateral surfaces of the ankle. X-rays of the foot may not yet show any changes.
- In the second stage, the pain stabilizes, a crisis appears when moving the joint, mobility is limited, and the joint gives "jaws". When examined on X-ray, growths along the edges of the articular surfaces of bones are noticeable: tibia, ankle and talus, as well as narrowing of the joint space.
- In the third stage, the joint is deformed, so only rocking, low-amplitude movements are possible. X-rays reveal massive bone growths, the joint space is sharply narrowed or even absent. Due to the instability of the joint, patients often bend their legs, which only aggravates the situation due to sprains, tearing of ligaments and deterioration of the general condition.
Pain with ankle arthrosis has characteristic features:
- The maximum expressed at the beginning of the movement — the so-called initial pain
- In particular, the load increases significantly during running and jumping
- It often appears in the evening, at night, or immediately after waking up
There is limited mobility of the leg due to pain, as well as congestion in the joint due to cartilage destruction.
Symptoms appear in waves: exacerbations alternate with remissions. With exacerbation, the symptoms become more obvious. During remission, symptoms gradually decrease and may even disappear completely.
Which doctor should I see?
If you experience pain and stiffness in ankle movements, you should consult an orthopedic traumatologist. If another cause of joint discomfort is identified, consultation with a neurologist, rheumatologist or endocrinologist may be required.
Diagnostics
To make a diagnosis, the doctor clarifies the complaints, shows how long the pain has been observed, what contributes to its appearance and intensity. The specialist collects information about existing diseases, injuries and lifestyle characteristics, conducts examinations, assesses joint range of motion and performs diagnostic tests.
Based on the information already received, it is possible to assume the diagnosis, but to confirm it and draw up 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 the diagnosis and determining the stage of the disease. The images show narrowing of the joint space, osteophytes on the edges of the articular surfaces of the bones, cysts and thinning of the bone under the cartilage.
- A CT scan of the joint shows 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
- Joint ultrasound to assess the condition of soft joint structures
Treatment of arthrosis
The treatment of pathology is long-term and is carried out in an outpatient setting under the supervision of an orthopedic traumatologist. How to treat arthrosis of the foot depends on the stage of damage and existing complications.
The main goals of treating the disease in a modern clinic are to eliminate leg pain, improve the patient's quality of life, and slow down the progression of arthrosis. To do this, the doctor prepares a number of medicinal and non-medicinal therapeutic and preventive measures, as well as adjusts the patient's lifestyle.
Correction of lifestyle and nutrition
Sufficient physical activity and nutritional correction will help prevent degenerative changes. After the examination, the clinic's doctors can make recommendations for weight loss and 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, difficult-to-treat pain
Exercise therapy
Specially selected exercises help maintain the range of motion in the joint, reduce pain and prevent the development of degenerative changes. The patient first performs the recommended exercises under the supervision of a specialist, then - alone, at home.
Massage
Massage of the lower extremities normalizes the nutrition of joint tissues. It is prescribed outside the acute phase. During the session, the specialist performs passive movements on the joint, which prevents muscle shortening and joint stiffness.
Auxiliary devices
Special orthoses, canes, and walkers may be recommended to relieve stress and stabilize the ankle.
Surgery
It is used only in cases of severe destruction of articular cartilage and limited mobility of joints. After the operation, rehabilitation and conservative treatment are carried out for a long time. In the later stages of ankle arthrosis, endoprosthetic or arthroplasty is practically the only possibility to avoid disability and maintain joint mobility.
Why is ankle arthrosis dangerous?
Changes already formed in the joint are irreversible. Therefore, treatment is aimed at slowing down the pathological process in order to preserve the patient's ability to work and quality of life. Such goals can be achieved only by timely treatment and strict adherence to the doctor's recommendations.
As arthrosis develops, an open deformation of the joint occurs. The range of motion is sharply reduced, as a result of which it becomes difficult to support the leg, it is almost impossible to walk without crutches or a cane.
Chronic, constant pain in the joint causes anxiety and depressive disorders.
Prevention
Prevention of arthrosis includes the following measures:
- Avoid traumatic activities. For example, jumping from a great height, 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
- Be moderately active
- An inactive lifestyle is dangerous and leads to complications, as well as overuse and microtraumas.
- Keep your joints healthy
- Consult a doctor immediately and treat musculoskeletal disorders
Key points from the article:
- The prevalence of degenerative-dystrophic diseases of the foot joints is 87%.
- Occupational hazards, daily habits, and past injuries can cause arthrosis of the ankle joint.
- A common symptom of arthrosis — pain accompanied by a creaking sound when moving, local swelling and then limited mobility of the leg
- Treatment of ankle arthrosis is often conservative and includes both drug and non-drug methods.
- Progression of ankle arthrosis leads to disability and complete loss of foot function