Osteoarthritis of the ankle joint

In recent years, experts from 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 severe 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.

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 lower leg, which form the inner and outer ankles (ankles), as well as the talus of the foot. From the inside, it is reinforced 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 common ligaments and muscle tendons with the joints of the foot.

Arthrosis of the ankle joint is a degenerative-dystrophic disease that begins with the thinning and destruction of articular cartilage, reducing its depreciating 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 ICD-10 ankle joint osteoarthritis code is M19.

The disease is less common than a similar knee injury and is usually the result of serious injury or long-term injury 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:

• 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 metabolism in 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, which leads to infringement of the spinal roots and weakening of the muscles of the lower leg and foot, leading to joint instability and injury.

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. This leads to injury to the subcartilaginous layer of the bone. It thickens (sclerosing) and grows along the edges of the joint surfaces. These growths are called osteophytes. They compress soft tissues, blood vessels and nerves, causing pain and further impairing blood circulation.

Due to circulatory disorders and high tension, the muscles suffer, weaken, which leads to joint instability and frequent dislocations. Arthrosis of the foot develops, the small tarsal joints, the metatarso-tarsal, metatarsophalangeal and interphalangeal joints are affected.

Gradually, connective tissue grows in the joints, tightly binding the joint surfaces together and disrupting joint function. Complete loss of ankle function is associated with fusion of the bone articular joints. Foot osteoarthritis also develops gradually.

Symptoms of ankle osteoarthritis

Ankle osteoarthritis progresses slowly and imperceptibly at first. But the symptoms appear and gradually increase, indicating some kind of violation in the lower extremity.

first signs

The first symptom of ankle arthrosis is pain during high loads, for example, when walking a lot, 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. The pain can be both symmetrical in both joints (with high loads and microtrauma), and unilateral (after a major injury).

Then there is a feeling of stiffness in the morning or after a long stay in a state of immobility. The ankles become stiff for a while, making movement difficult. In the initial stages it lasts a few minutes and passes after a slow pace. This symptom should already alert and become a reason to go to the doctor.

Overt symptoms

Gradually, the pain after exertion intensifies and lasts longer. The leg can ache all day. Night pains join, they usually appear in the second half of the night and are sometimes accompanied by painful muscle cramps. Periods of rigidity after immobility are also lengthened.

Due to severe pain, a person begins to limp while walking, try to reduce the pain in the foot by stretching or pressing on it. Sometimes the ankle swells, the skin covering it turns red, the pain intensifies. This is a sign of synovitis, inflammation of the inner synovial membrane. The inflammation is noninfectious 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 joint 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 acquires a different shape due to too large osteophytes. Arthrosis 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, 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 of the big toe out.

What is dangerous ankle arthrosis?

The danger is that the disease at first develops imperceptibly and very often the patient goes to the doctor, already having an advanced stage.

Any location and form of osteoarthritis has serious complications, so treatment should not be delayed.

Classification

Ankle osteoarthritis 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 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. Usually one joint is injured, so post-traumatic osteoarthritis is one-sided. A small but untreated injury may not make itself felt at first. And only after some time, when a person has already forgotten about it, does a slight growing pain appear. This type of injury is dangerous because the patient comes to the doctor already in a state of abandonment. Serious injuries are better treated, their consequences appear earlier, and the patient seeks medical help not so late.

Discreet long-term microtraumas of both ankles are typical for professional dancers, athletes and people whose profession is associated with long standing. There are symmetric pains in the ankles during physical exertion. They are often confused with muscle pain with fatigue, so it is also too late to go to the doctor.

Ankle osteoarthritis after arthritis.

The causes of these osteoarthritis 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 destroying the ankle. With an exacerbation of inflammation, the joints swell, the skin covering them turns red, the pain becomes very severe, especially at night. When inflammation subsides, metabolic disturbances predominate, while all processes develop very rapidly. 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 the joint tissues, and after recovery, connective tissue forms in its 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

It develops with a long course of gout. Most often, the first toe is affected. Other small joints of the foot and ankle are affected less frequently. Since gout attacks continue, it is difficult to determine externally when the degenerative-dystrophic process occurs. It can only be seen on an x-ray. In any case, the patient should be regularly observed by a rheumatologist and periodically examined.

Deforming osteoarthritis of the ankle joint.

All types of osteoarthritis become disfiguring over time. Bone deformities indicate an advanced stage of the disease, when the cartilage has already collapsed, and the constant mechanical impact on bone tissue contributes to its growth along the edges of the articular surface. This is how osteophytes are formed that modify the joint shape.

Degrees of arthrosis of the ankle joint.

There are several classifications, one of which distinguishes three clinical and radiological stages of osteoarthritis:

1. Early. Some pain after standing or walking for a long time, some stiffness in the morning. All of this quickly disappears without any help. X-ray: normal or slight narrowing of the joint space.
2. progressive. The pain after physical exertion is stronger and longer. Stiffness increases, a crunch appears in the joints during movement. Sometimes the joint becomes swollen, red and very painful - a sign of synovitis. The radiograph shows significant narrowing of the joint space, thickening of the subcartilaginous bone tissue (osteosclerosis), and proliferation of osteophytes.
3. Final. The pain syndrome intensifies, becomes permanent. Due to the pain, the person limps, draws their feet, uses a cane or crutches. The function of the limb is impaired, arthrosis of the foot and thumb develops. The total absence of flexion-extension movements is rare, usually in the context of osteoarthritis-arthritis. On the radiograph: no joint space, osteosclerosis, large osteophytes deforming the joint.

Possible complications

If the disease is not treated and let everything take its course, the following complications are possible:

• persistent joint dysfunction and disability;
• severe and incessant pain in the ankle and feet, both after exertion and without it;
• ankle instability with the development of usual dislocations and subluxations;
• damage to the foot and thumb will join, which will further aggravate the patient's condition.

Diagnosis of ankle osteoarthritis

Before prescribing treatment, the doctor conducts an examination of the patient, which includes:

• interview and medical examination;
• additional research methods: laboratory tests (signs of inflammation and metabolic disorders are detected), instrumental studies (x-ray of the joint in two projections, magnetic and computed tomography: 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 pharmacological and non-pharmacological methods.

Medical treatment of osteoarthritis of the ankle joint

Drugs are prescribed that have a symptomatic (eliminates the symptoms of the disease) and pathogenic (suppresses the mechanism of the development of the disease) effect.

Anti-inflammatories and analgesics

To eliminate pain, drugs from the group of nonsteroidal 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 performing its movement are in constant tension, which leads to its atrophy and increases pain. To eliminate muscle spasms, drugs from the group of muscle relaxants are prescribed.

Chondroprotectors

Drugs from the group of chondroprotectors contain glucosamine or chondroitin, and sometimes both 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 osteoarthritis of the ankle joint

To improve the buffering capacity of synovial fluid and prevent further injury to cartilage and bone tissues, hyaluronic acid is injected into the joint cavity. This results in pain relief and better joint mobility.

Anti-arthrosis gels and ointments for arthrosis of the ankle joint

External media can be used at home. Ointments for arthrosis of the ankle joint:

• NSAID gels are suitable for relieving pain and inflammation;
• to restore cartilage - chondroitin-based gel and ointment.

non-pharmacological therapy

The main methods of treating ankle osteoarthritis are not drugs. These are therapeutic exercises, massage, physiotherapy, use of orthopedic devices.

Physiotherapy

To alleviate the patient's condition and restore joint function, appoint:

• electrophoresis with medicinal substances;
• laser therapy;
• magnet therapy;
• heating procedures - paraffin, ozokerite, in spa conditions - mud applications.

Massage for arthrosis 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 keep 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 greatly restore the function of the limb, even with advanced disease.

An approximate set of exercises (but before starting their implementation, you should 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 an orthosis is prescribed by a doctor, who also selects the most suitable model.

Ankle fixation can also be done with tape: 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 treatment methods, as well as for significant dysfunction of the limb.

Types of surgical interventions

Operations can be carried out in a traditional and smooth way:

1. Therapeutic arthroscopy (conservative operations):
   • sanitation of 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 autocartilage sections 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.
2. Arthrodesis is a traditional surgical operation. It is carried out with a significant violation of the function of the limb, its looseness, usual dislocations and pain. The joint is removed, the bones of the lower leg are fused with the bones of the foot. The ankle becomes immobile and serves only as a support.
3. 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 full rehabilitation. With conservative operations, rehabilitation is carried out on an outpatient basis with an early inclusion in the course of therapeutic exercises, with the exception of high loads on the joint. After the endoprosthesis, 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 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 be provided with adequate 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 only 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 drink half a glass 4 times a day for a month; analgesic, restoration of cartilage tissue;
• for oral administration - take a mummy ball with a diameter of 0. 5 cm in the morning, chewing well, 30 minutes before meals for 10 days; rest 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 gently rub, massaging the tissues, for 5 minutes; then wrap the leg in a warm shawl and leave it until morning; restores blood circulation and metabolism in cartilage tissue.

Approach to treatment in clinics

The doctors at the clinic have developed their own approach to the treatment of diseases such as ankle and foot osteoarthritis. During the initial appointment, a full 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. Consists in:

• modern schemes of pharmacological and non-pharmacological treatment of arthrosis: drugs, physiotherapy, exercise and massage therapy, ankle fixation methods;
• traditional methods of oriental therapy: acupuncture, moxibustion, acupressure, various methods of kinesiotherapy, including bandaging.

These are not all the methods used in clinics. Doctors can combine Western and Eastern methods, which significantly accelerates 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 foot osteoarthritis.

To reduce the risk of disease progression, the following recommendations should be followed:

• activity, exercise therapy exercises, swimming should become a 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 considering the forms of movement and the footwear used;
• rational nutrition is necessary to restore metabolism, but being overweight is an additional load on the ankle, get rid of it;
• Preventive treatment courses are a guarantee of a life without pain.

Frequently asked questions about the disease

1. 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.

2. 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 better to do it at the beginning of the disease, not to wait for complications to appear.

3. Can children develop ankle osteoarthritis?

   Perhaps after an injury or in the context of a congenital pathology.

4. What are the consequences of the disease?

   Untreated osteoarthritis 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.

5. Are sports injuries a cause of ankle osteoarthritis?

   Yes, sports injuries are one of the main causes of this disease.

6. Is it possible to do an ankle bandage with arthrosis?

   It is possible, but it must be done by a specialist.

Osteoarthritis of the ankle joint is almost always the result of macro or micro trauma. It proceeds slowly and imperceptibly at first. Therefore, timely treatment and rehabilitation after injuries are very important, as well as contacting a doctor at the first signs of ankle disease.