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 injury or permanent microtrauma in athletes, professional dancers, circus performers. How to spot the signs of the disease in a timely manner and stop its progression, as well as how it is treated, you will learn from this article.
Ankle arthrosis - what is it
The ankle is a complex block -like joint formed by the lower end (distal) of the tibia and the fibula of the lower leg, forming the inner and outer ankle (ankle), 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 legs. The ankle is functionally connected to the foot, has common ligaments and muscular tendons with the foot joint.
Arthrosis of the ankle joint is a degenerative-dystrophic disease that begins with thinning and destruction of the articular cartilage, reducing its depreciating nature, followed by the inclusion of all other articular tissues in the pathological process. The disease gradually leads to complete wear and tear of the joints and disability. The code for ICD-10 ankle joint arthrosis is M19.
The disease is less common than similar knee lesions 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 causes of the development of arthrosis of the ankle joint and arthrosis of the foot. this:
- injuries - intra -articular fractures of joints, ankle fractures, complete and incomplete rupture of ligaments and tendons;
- microtrauma caused by any professional activity - these are ballerinas, dancers, professional athletes;
- increased load on the legs with excess 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. ;
- hormones, including age -related changes;
- transferred severe acute purulent arthritis;
- long-term chronic arthritis of any origin;
- osteochondrosis of the lumbar spine and intervertebral hernia, causing violation of the spinal roots and weakening of the muscles of the legs and lower legs, leading to joint instability and injury.
Mechanisms of disease development (pathogenesis)
Under the influence of various causes, blood circulation in the articular area is disrupted, leading to a decrease in the amount of synovial fluid that consumes cartilage tissue. Due to lack of oxygen and nutrients, the cartilage becomes thinner, cracks and corrosion appear on it. This leads to injury to the subcartilaginous layer of bone. It thickens (sclerosing) and grows along the edges of the articular surface. These growths are called osteophytes. They compress soft tissues, blood vessels and nerves, causing pain and in turn disrupting blood circulation.
Due to circulatory disorders and high tension, muscles suffer, they are weak, which leads to joint instability and frequent dislocations. Leg arthrosis develops, small tarsal joints, metatarsal-tarsal, metatarsophalangeal and interphalangeal joints are affected.
Gradually, connective tissue grows in the joints, binding the articular surface tightly and interfering with articular function. Complete loss of ankle function is associated with fusion of bone articular joints. Leg arthrosis also gradually develops.
Symptoms of osteoarthritis of the ankle
Ankle arthrosis occurs slowly and is not visible at first. But the symptoms gradually appear and increase, signifying some kind of violation of the lower limbs.
The first signs
The first symptom of ankle arthrosis is pain during high loads, for example, during long walks, dancing, playing football or volleyball, etc. This pain passes quickly, so the person does not immediately pay attention to it, associating it with muscle fatigue. Pain can be symmetrical in both joints (with high loads and microtraumas), and unilateral (after major injuries).
Then there is a feeling of stiffness in the morning or after a long stay in a state of immobility. The ankle becomes stiff for a while, making it difficult to move. In the early stages it lasts a few minutes and passes after a slow step. These symptoms should already be on the alert and be a reason to go to the doctor.
Obvious symptoms
Gradually, the pain after exercising gets stronger, and lasts longer. Legs can ache all day. Night pain accompanies, it usually appears in the second half of the night and is sometimes accompanied by painful muscle spasms. The period of stiffness after immobility is also prolonged.
Due to the severe pain, a person begins to drown while walking, trying to reduce the pain in the leg by stretching or pressing on it. Sometimes the ankle swells, the skin on it turns red, the pain increases. This is a sign of synovitis - inflammation of the inner synovial membrane. Inflammation is non -infectious, develops from mechanical irritation and disappears on its own without treatment. But at the same time, the exacerbation of synovitis activates the development of articular degenerative-dystrophic processes.
Dangerous symptoms
Persistent pain, exacerbated by physical exertion, instability, joint relaxation, tendency to subluxations, dislocations and ligament injuries are dangerous symptoms that require a visit to the doctor. The ankle changes externally: it takes on a different shape due to the osteophyte being too large. Arthrosis of the ankle (ankle) leads to its thickening. Movement in the foot is initially slightly limited, and then the ankle becomes immobile or, conversely, loose, unstable. But at this stage, the patient can be helped, you just need to contact the clinic. Symptoms of foot arthrosis appear: pain in the foot, violation of 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 outwards.
Is arthrosis dangerous of the ankle
The danger is that the disease initially develops invisibly and often the patient goes to the doctor, after advanced stages.
Any localization and form of arthrosis has serious complications, so you should not delay treatment.
Welding
Ankle arthrosis can be primary, when the cause of its development is not established, and secondary, with a known original cause. Depending on the cause of development, the disease may have its own characteristics.
Arthritis after trauma of the ankle joint
Consequences of traumatic injury are the most common cause of illness. Arthrosis after trauma of the ankle joint can develop after major injuries - ligament rupture, dislocation, intra -articular fracture. Usually one joint is injured, so post -traumatic arthrosis is next. Minor but untreated injuries may not be felt at first. And only after a while, when one has forgotten about it, does a growing pain appear. This type of injury is dangerous because the patient goes to a doctor who is already in a neglected state. Serious injuries are better treated, the consequences appear faster and patients seek medical help not too late.
Unobtrusive long-term microtrauma to both ankles is typical for professional dancers, athletes and people whose profession is associated with long standing periods. There is symmetrical pain in the ankle while doing physical exercise. They are usually mistaken for muscle aches with fatigue, so it’s too late to see a doctor.
Ankle arthrosis after arthritis
The cause of this arthrosis can be a chronic inflammatory process in the joints (arthritis): rheumatoid, reactive, psoriatic. In this case, the inflammatory process is combined with degenerative-dystrophic (arthritis-arthritis). This speeds up the process of ankle destruction. With the worsening of inflammation, the joints swell, the skin on them becomes red, the pain becomes very severe, especially at night. When inflammation subsides, metabolic disorders predominate, while all processes develop rapidly. The disease requires constant monitoring and treatment by a rheumatologist.
More rarely, degenerative-dystrophic processes develop after experiencing acute purulent arthritis. The purulent process destroys the articular tissues and, after recovery, connective tissue forms in their place, which interferes with the function of the limbs.
Arthrosis can also form after infectious arthritis - tuberculosis, gonorrhea, etc. The development of the disease is associated with major infectious processes and destructive nature. If the infection persists, joint destruction will develop.
Metabolic
Develops with prolonged gout. Often the first toe is affected. Other small joints in the foot and ankle are less affected. Given persistent gout attacks, it is difficult to determine externally when a 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 examined periodically.
Deformation of the ankle joint arthrosis
All types of arthrosis become deformed over time. Bone defects indicate an advanced stage of the disease, when the cartilage has 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 form that change the shape of the articular.
Stages of arthrosis of the ankle joint
There are several classifications, one of which distinguishes three clinical and radiological stages of arthrosis:
- early. A little pain after standing or long walks, a little stiffness in the morning. All of this disappeared quickly without any help. X-ray: normal or slight narrowing of the joint space.
- progressive. Pain after doing physical exercise is stronger and longer. Stiffness increases, dryness appears in the joints during movement. Sometimes the joints are swollen, reddened and very painful - a sign of synovitis. X-rays showed significant narrowing of the joint space, thickening of subcartilaginous bone tissue (osteosclerosis), and osteophyte proliferation.
- The end. The pain syndrome intensifies, becoming permanent. Because of the pain, a person is lame, limping, using a cane or cane. Impaired limb function, arthrosis of the foot and thumb develops. Complete absence of flexion-extensor movement is rare, usually against the background of arthrosis-arthritis. On x-ray: no joint space, osteosclerosis, large osteophytes that change the shape of the joint.
Possible Complications
If the disease is not treated and let everything go smoothly, the following complications may occur:
- persistent joint dysfunction and disability;
- persistent severe pain in the ankles and feet, both after exercise and without it;
- ankle instability with the development of common dislocations and subluxations;
- damage to the foot and thumb will merge, which will worsen the patient’s condition.
Diagnosis of ankle arthrosis
Before prescribing treatment, the doctor conducts an examination of the patient, including:
- interviews and medical examinations;
- Additional research methods: laboratory tests (signs of inflammation and metabolic disorders detected), instrumental studies (radiography of joints in two projections, magnetic resonance imaging calculations - initial changes in bone and soft tissue structure detected), diagnostic arthroscopy (the internal articular surface is examined).
Treatment of ankle joint arthrosis
After setting the final diagnosis, the doctor selects an individual treatment complex for the patient, which consists of drug and non -drug methods.
Medical treatment of osteoarthritis of the ankle joint
Prescribed drugs that have a symptomatic effect (eliminate the symptoms of the disease) and pathogenetic (suppress the mechanism of disease progression).
Anti-inflammatory and painkillers
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 patches.
Relax your muscles
The muscles that surround the diseased joint and carry out its movements are in constant tension, which leads to atrophy and increased pain. To eliminate muscle spasms, medications from the muscle relaxant group are prescribed.
Chondroprotectors
Drugs from the group of chondroprotectors contain glucosamine or chondroitin, and sometimes both of these substances. They protect cartilage cells from destruction and promote their recovery. They are prescribed in the form of injections, tablets and external agents (creams and ointments).
Preparations of hyaluronic acid for arthrosis of the ankle joint
To increase the cushioning ability of synovial fluid and prevent further injury to cartilage and bone tissue, hyaluronic acid is injected into the joint cavity. This results in pain relief and increased joint mobility.
Antiarthrosis gels and ointments for arthrosis of the ankle joint
External means can be used at home. Ointment for arthrosis of the ankle joint:
- NSAID gels are ideal for relieving pain and inflammation;
- to restore cartilage - gels and ointments based on chondroitin.
Therapy is not a drug
The main method of treating ankle arthrosis is non -medication. These are therapeutic exercises, massage, physiotherapy, wearing orthopedic devices.
Physiotherapy
To alleviate the patient's condition and restore joint function, appoint:
- electrophoresis with medical materials;
- laser therapy;
- magnetotherapy;
- heating procedures - paraffin, ozocerite, in resort conditions - mud application.
Massage for osteoarthritis of the ankle joint
The course of massage improves blood circulation, which leads to the activation of metabolism, restoration of articular and extra-articular tissues. The positive effect of massage on muscles is the elimination of cramps, which contribute to blood flow to the muscles, and the restoration of their strength, which is necessary to hold the limbs in the desired position.
Exercise and exercise therapy for ankle joint arthrosis
Therapeutic gymnastics is a cure for arthrosis. Motor activity is very important, in addition to exercise therapy, swimming is useful. Systematic implementation of exercises selected by the doctor allows you to restore most of the function of the limbs, even with advanced diseases.
A set of approximate exercises (but before you start their implementation, you should consult with your doctor):
Use of special orthopedic products
To prevent the development of the disease, the doctor may prescribe the use of special orthopedic devices - orthoses. It corrects the foot in the correct anatomical position, relieves muscle tension, improves blood circulation. Wearing an orthosis is prescribed by a doctor, who also selects the most appropriate model.
Ankle fixation can also be done using adhesive tape: with special adhesive tape, the ankle is fixed gently to the desired position.
Surgical intervention
Surgery is recommended for severe pain that is not eliminated by conservative treatment methods, as well as for significant limb dysfunction.
Types of surgical interventions
The operation can be carried out in a traditional and gentle way:
- Therapeutic arthroscopy (economical operation):
- articular cavity sanitation - 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 cartilage layer is removed, which stimulates the growth of new cartilage cells (coarse chondroplasty); in some cases, transplantation of an autocartilage portion taken from an unloaded area of the patient’s knee joint (mosaic arthroplasty) is performed; chondroplasty is effective in stage 2 of the disease, when the joint has not yet lost its function.
- Arthrodesis is a traditional surgery. It is carried out with significant violations of limb function, its relaxation, normal dislocation and pain. The joints are removed, the bones of the lower leg unite with the bones of the foot. The ankle becomes immobile and only serves as a support.
- Endoprosthetics are the replacement of worn and lost ankle function with an artificial one.
Features of postoperative recovery
All operations are carried out at rest, after which experts recommend full recovery. With prudent surgery, rehabilitation is carried out on an outpatient basis with early inclusion in the course of therapeutic training with the exception of high loads on the joints. After endoprosthetics, the patient stays in the hospital for a week, and then rehabilitation measures are performed on an outpatient basis. After two weeks, the sutures are removed and the patient can bathe.
Diet food
There is no special diet for osteoarthritis. But to eliminate unnecessary pressure on the ankle, it is necessary to maintain a normal weight. One should receive a proper healthy diet, but high calorie foods should be partially replaced with vegetables and fruits. The first and second low -fat dishes, 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; analgesics, restore cartilage tissue;
- for oral administration: take a mummy ball with a diameter of 0. 5 cm in the morning, chew thoroughly, 30 minutes before meals for 10 days; rest 5 days, then repeat everything 3 more times; excellent stimulant of metabolic processes;
- honey massage: apply warm melted honey on the ankles before bed and rub gently, massaging tissues, for 5 minutes; then wrap the feet in a warm scarf and leave until morning; restores blood circulation and metabolism in cartilaginous tissue.
Treatment approach in the clinic
Clinical doctors have developed their own approaches 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 history of the disease, after which he prescribes additional laboratory and instrumental studies, including MRI. Only after that the doctor sets the final diagnosis, prescribes and agrees with the patient on complex treatment. Consists of:
- modern schemes of drug and non -drug treatment of arthrosis - medication, physiotherapy, exercise therapy and massage, methods of fixation of the ankle;
- traditional methods of oriental therapy - acupuncture, moxibustion, acupressure, various methods of kinesiotherapy, including recording.
These are not all methods used in the clinic. Doctors are able to combine Western and Eastern methods, significantly accelerating the improvement of the patient's condition. Patients quickly get rid of the pain, their quality of life improves significantly.
A combination of Eastern proven techniques and innovative methods of Western medicine.
Prevention of foot arthrosis
To reduce the risk of disease progression, the following recommendations should be followed:
- activities, exercise therapy training, swimming should be a part of your life;
- high physical activity and any traumatic factors should be excluded; climbing should be combined with rest, if the foot is injured during work, then it is worth changing it;
- injuries, especially in winter on ice, should be ruled out by considering the manner of movement and the shoes used;
- rational nutrition is needed to restore metabolism, but excess weight is an additional burden on the ankles, get rid of it;
- a course of preventive treatment is a guarantee of a pain -free life.
Frequently asked questions about this disease
- Which doctor should I contact for osteoarthritis of the ankle joint and arthrosis of the foot?
To an orthopedic-traumatologist. But if the disease develops against the background of some kind of rheumatic process, then to a rheumatologist.
- What are the predictions usually given by doctors?
It is possible to stop the development of degenerative processes 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?
Probably after an injury or on the background of congenital pathology.
- What are the consequences of the disease?
Untreated arthritis leads to disability. If you start treating on time, it is possible to maintain limb function. Treatment at a later stage will relieve pain and improve quality of life.
- Are sports injuries the cause of ankle osteoarthritis?
Yes, sports injuries are one of the leading causes of this disease.
- Is it possible to do an ankle recording with arthrosis?
It is possible, but this should be done by an expert.
Arthrosis of the ankle joint is almost always caused by macro or microtrauma. It runs slowly and is invisible at first. Therefore, timely treatment and rehabilitation after an injury is very important, as well as contacting a doctor at the first signs of ankle disease.