Arthrosis of the ankle joint is a degenerative, dystrophic disease of the structures of the musculoskeletal system. Affects the lower extremity. It is considered one of the most common forms of arthrosis: it accounts for up to 30% of the total number of degenerative-dystrophic joint damage cases. The pathological process occurs not only in elderly patients. About a quarter of patients are under the age of 40.
The disorder is accompanied by constant pain and a gradual decrease in joint and lower limb function. Without treatment, it progresses and does not go away on its own. Diagnosis and treatment of the disorder is the work of an orthopedic doctor (a traumatologist, as well as physical therapy doctors and physiotherapists are involved depending on the underlying cause).
Causes of ankle arthrosis
Osteoarthritis is considered a polyetiological disease. Its development occurs as a result of the influence of a group of causes. With age, the number of factors provoking the disease increases, therefore, the probability of the pathological process increases. But everything is not so simple.
Pathogenesis of the disorder
There are a group of causes of ankle arthrosis, the most common of which are:
- irrational physical activity;
- injuries;
- operations;
- metabolic diseases;
- uncomfortable shoes;
- other diseases of the musculoskeletal system;
- Rheumatoid diseases.
Irrational stress can be a result of lifestyle or career choices. Constant walking, standing in one place, carrying heavy objects, intense activity. All these are medium-term (several years) provocateurs of the pathological process.
Another reason is injuries, especially intra-articular fractures, dislocations and also severe bruises (less often). Arthrosis of the ankle joint appears imperceptibly, but constantly progresses. Often patients do not appreciate the consequences of the trauma.
Operations can provoke arthrosis. However, such a complication is relatively rare. Mainly due to incorrect assessment of the clinical situation. Insufficient qualification of the doctor.
Metabolic pathologies, such as diabetes, can cause disorders. However, much more often the causes of ankle arthrosis are gout, as well as hormonal disorders (for example, during menopause).
Uncomfortable shoes are one of the main factors in the development of the pathological process. The disorder develops due to the incorrect distribution of the load on the leg. Complex disorders usually develop: not only arthrosis, but also spinal injuries. At least - osteochondrosis. But more dangerous problems are also possible.
Dysfunctions of the locomotor system itself also increase the likelihood of a pathological process. Intervertebral hernia, osteochondrosis and congenital disorders create additional risks.
Rheumatoid diseases are represented by arthritis, systemic lupus erythematosus. Degenerative-dystrophic injuries are secondary, but aggravate the main disease and worsen the prognosis.
Arthrosis of the ankle joint is a multifactorial disease. As a rule, it develops under the influence of several reasons at the same time. There are exceptions, but they are rare. Also, the number of factors affects the severity of the disease and the rate of progression of the pathological process.
The development of the pathological process is gradual. At the initial stage, local blood circulation and dynamic load distribution on the leg are disturbed. Destructive processes in the cartilage are gradually added. Sluggish inflammation begins. Degeneration of other ankle structures occurs: capsule, ligaments, bones, etc. Sh. The more advanced the disease, the more difficult it is to treat. It takes more effort and time.
Increased risk factors for the development of arthrosis
Dystrophic destruction of ankle joint tissues occurs not only as a result of direct causes. Risk factors influence the severity, probability and nature of the disease. They complete the picture of violation. Between them:
- the habit of wearing heels;
- Physically difficult nature of work (including professions that have an obvious risk: teachers, cooks also get sick);
- previous injuries of the ankle joint (there are cases when the disorder appeared years after the injury);
- history of endocrine diseases (hormonal disorders create additional risks);
- history of diseases of the musculoskeletal system;
- 40+ age (although the disease occurs in young people as well);
- increased body weight;
- Gender (women suffer more often than men).
Arthrosis of the ankle joint is a disease that develops slowly, symptoms do not appear immediately. Therefore, it is difficult to assess what risk factors and causes lead to the pathological process. It is necessary to collect a complete medical history.
Classification and types of ankle joint injuries
Pathology is classified according to two bases.
The first criterion is the origin of the pathological process. Mark:
- post-traumatic form of the disorder (develops after injuries to the ankle joint or other structures of the musculoskeletal system);
- Deformed arthrosis of the ankle joint: the result of metabolic disorders or injuries, accompanied by slow but stable deformation of the joint;
- Metabolic arthrosis develops against the background of diabetes, hormonal disorders or gout (purine metabolism disorder).
The second basis of classification is based on the stage of the pathological process. In its development, arthrosis of the ankle joint goes through the following stages:
- initial or early;
- progressive;
- Advanced arthrosis.
In the first stage, the clinical picture as such does not exist or appears after intense physical exertion. The pathological process is detected only with the help of special diagnostic methods.
The progressive phase of the disorder is accompanied by strengthening of the clinic. Symptoms appear after light physical exertion. Load tolerance decreases. There is a constant pain syndrome, as well as limited mobility of the foot in the ankle joint.
The final phase of the pathological process is accompanied by severe pain, as well as other symptoms in a state of complete rest. Both auxiliary and motor functions are impaired. Often a person becomes disabled. Complex surgical treatment is required, including endoprosthesis.
Important!
The stage plays a major role in determining the treatment tactics and predicting the course and outcome of the disease. The disorder is best treated in its early stages. The more advanced the pathology, the more difficult and time-consuming correction is.
Symptoms of the disorder
The clinical picture depends on the form and stage of the pathological process. Typical manifestations are:
- pain
- tiredness
- exercise intolerance;
- swelling;
- violation of the supporting function of the leg;
- muscle weakness.
Leg pain is initially noticed only after intense physical activity. Then a little activity is enough. In the advanced stage of the pathological process, pain is always there, regardless of the load.
Fatigue is observed from the very first stage of the disorder. Along with the disease, the feeling of muscle weakness and increased fatigue progresses. Signs indicate further development of the disorder.
Exercise tolerance also decreases gradually. In the pronounced stage of the disorder, a person cannot climb to the second or third floor. We have to make stops.
Swelling is a sign that is always there. The leg near the ankle looks swollen and enlarged. This is a non-specific manifestation.
Initial pain is characteristic. After staying in one place for a long time, a strong stiffness of the joint develops. The first movements cause a lot of discomfort. Pain and discomfort gradually disappear as the person continues to move.
The clinical picture depends on the degree of arthrosis of the ankle joint. It plays a major role in determining the stage and severity of the pathological process. The physician systematizes the symptoms through a process of oral questioning and history taking.
The disease is characterized by a chronic course. In the period of exacerbation, the signs of arthrosis of the ankle joint are most clearly manifested. In the chronic phase, remission is only partial. The clinic is not so clear, but the symptoms do not disappear completely. Then there is a new exacerbation of arthrosis of the ankle joint, the symptoms become intense again. And so on in the next circle until quality treatment is done.
Complications of ankle arthrosis
Complications of the pathological process relate to the maintenance of working capacity and the ability to take care of oneself.
Patients have ankle deformity. The pathological process ends with the formation of contractures, areas of primary or complete immobility of the ankle limb. The situation can be corrected only by surgery.
During an exacerbation, the development of synovitis and inflammation of the synovial bursa are characteristic. This condition lasts for several weeks and in its acute course it completely eliminates the ability to work and move.
The final result of the pathological process is a decrease in the supporting function of the leg and then a complete loss, the person cannot move normally. You must use crutches. Complete loss of working capacity, and in some cases, the ability to care for oneself. In the advanced stages of ankle arthrosis, patients become disabled.
Diagnosis of the disease
Diagnosis of damage to articular structures and cartilage tissue is carried out under the supervision of an orthopedic traumatologist. Examinations are typical. It is not difficult to identify the pathological process, as well as its degree of severity. Among the techniques:
- Oral questioning of the patient to better understand the nature of symptoms and health complaints;
- collection of anamnesis, which allows you to determine the likely origin of the pathological condition;
- Palpation: arthrosis is indicated by deformation, swelling, pain during passive movements;
- Radiography of the ankle: a routine examination that provides sufficient information to determine the diagnosis and determine its severity is considered the gold standard examination;
- MRI or radiographic data are insufficient.
Other studies may be conducted. For example, computed tomography (arthrosis affects not only the cartilage, but also the bones; CT allows a detailed, accurate visual view of the nature of the disorders).
Notice!
Arthritis does not have specific manifestations, especially in the early stages. Therefore, independently, without sufficient knowledge, it will be impossible to distinguish pathological processes from each other. Special instrumental diagnostics is required.
Laboratory diagnostic techniques provide little data. They are only informative in terms of identifying the inflammatory process and help to diagnose some forms of arthrosis (metabolic origin, rheumatoid nature).
Treatment methods
Treatment of arthrosis of the ankle joint is carried out using conservative and surgical techniques. The best results can be achieved if you apply a complex correction.
Conservative therapy includes the use of medication, exercise therapy, and physical therapy with massage. The following drugs are used:
- local anti-inflammatory;
- general anti-inflammatory drugs (in the form of tablets or injection solutions);
- chondroprotectors;
- Nicotinic acid and other means to improve metabolic processes.
Exercise therapy and physical therapy, along with massage, are aimed at recovery after the acute condition has been eliminated. These methods are important during the remission period. If the disease proceeds in an acute form with pronounced clinical symptoms, the methods will be postponed.
In the case of deformations and permanent deviations of the joint anatomy, surgical treatment is required. Joint plastic surgery or endoprosthesis is possible, replacing the joint with an artificial analogue. This is a high-tech correction method.
forecasts
The prognosis depends on the moment of treatment, health condition, the cause of arthrosis, as well as the degree of development of the disorder. As the disease progresses, the situation becomes more complicated. If treatment is started on time, the prospects for cure and full recovery are good. In other cases, surgery and a long rehabilitation period are required.
Prevention of disorder
Prevention of ankle arthrosis includes:
- wearing comfortable shoes;
- timely treatment of diseases of the musculoskeletal system;
- reasonable welfare control;
- body weight control;
- Avoiding injury;
- load control.
Prevention can reduce the risk of ankle arthrosis by 2-3 times. The probability of a pathological process will be minimal.