Osteoarthritis of the ankle joint

In recent years, experts around the world have noted an increase in degenerative-dystrophic processes in the ankle, which gradually leads to disability. Osteoarthritis of the ankle joint often develops in athletes, professional dancers, circus performers as a result of serious injuries or permanent microtraumas. In this article you will learn how to feel the symptoms of this disease in time and stop its development, as well as how to treat it.

Osteoarthritis of the ankle - what is it

The ankle is a complex block-like joint formed by the lower (distal) ends of the calf bone of the lower leg, the inner and outer ankles (ankles), as well as the talus of the foot. The inside is strengthened by the deltoid ligament, the outside - by the anterior and posterior talofibular and calcaneofibular ligaments. Function: leg flexion and extension. The ankle is functionally connected to the foot, has common ligaments and muscle tendons in the joints of the foot.

Osteoarthritis of the ankle joint is a degenerative-dystrophic disease, which begins with the thinning and destruction of joint cartilage, a decrease in its amortization properties, and then the involvement of all other joint tissues in the pathological process. The disease gradually leads to complete wear and tear of the joint. The code for ankle arthritis is ICD-10 M19.

The disease is less common than a similar knee lesion and is usually the result of serious injuries or long-term injuries as a result of any activity.

Causes of ankle osteoarthritis

Specialists have studied in detail the causes of osteoarthritis of the ankle joint and the development of osteoarthritis of the foot. This is:

• injuries - intra-articular fractures of the joints, fractures of the ankles, complete and incomplete rupture of ligaments and tendons;
• microtrauma for any professional activity - these are ballerinas, dancers, professional athletes;
• increased load on the legs with excessive body weight;
• improper load distribution when wearing high-heeled shoes;
• Metabolic disorders that adversely affect the metabolism of cartilage tissue - diabetes mellitus, obesity, gout, etc. ;
• hormonal, including age-related changes;
• transplanted severe acute purulent arthritis;
• chronic arthritis of any origin;
• Osteochondrosis of the spine and intervertebral hernias causes damage to the spinal roots and weakens the muscles of the lower leg and foot, leading to joint instability and injuries.

Mechanism of disease development (pathogenesis)

Under the influence of various causes, blood circulation in the articular region is disrupted, which leads to a decrease in the volume of synovial fluid that nourishes the cartilage tissue. Due to lack of oxygen and nutrients, cartilage becomes thinner, cracks and erosions appear on it. This causes damage to the cartilage layer of the bone. It thickens (sclerosis) and grows along the edges of the articular surfaces. These growths are called osteophytes. They squeeze the soft tissues, blood vessels and nerves, causing pain and further disrupting blood circulation.

Due to circulatory disorders and high tension, the muscles suffer, they weaken, which leads to joint instability and often dislocation. Osteoarthritis of the foot develops, small joints of the tarsus, metatarsal-tarsal, metatarsophalangeal and interphalangeal joints are affected.

Gradually, the connective tissue grows in the joints, tightly closing the articular surfaces and disrupting articular function. Complete loss of ankle function is associated with the fusion of bone articular joints. Osteoarthritis of the foot also develops gradually.

Symptoms of osteoarthritis of the ankle

Osteoarthritis of the ankle initially progresses slowly and invisibly. However, the symptoms appear gradually and increase, indicating a kind of disorder in the lower extremities.

The first signs

The first symptom of ankle arthrosis is pain during high loads, such as long walks, dancing, playing football or volleyball, and so on. This pain passes quickly, so the person does not pay attention to it immediately, which is associated with muscle fatigue. The pain can be symmetrical in the joints (with high loads and microtraumas) and unilateral (after a major injury).

Then there is a feeling of stiffness in the morning or after a long stay in a sedentary position. The ankles harden for a while, making it difficult to move. The initial stages last a few minutes and pass after a slow tempo. This symptom should already be a warning and a reason to see a doctor.

Overt symptoms

Gradually, after exertion, the pain intensifies and lasts longer. The foot can hurt all day. Night pains are combined, usually appear in the second half of the night and are sometimes accompanied by painful muscle cramps. Periods of rigidity also extend after inactivity.

Due to severe pain, a person begins to stumble while walking, trying to reduce the pain in his leg by stretching or pressing it. Sometimes the ankle swells, the skin turns red, the pain intensifies. This is a sign of synovitis - an inflammation of the inner synovial membrane. Inflammation is non-infectious, develops as a result of mechanical irritation and resolves spontaneously without treatment. But at the same time, exacerbation of synovitis activates the process of articular degenerative-dystrophic process.

Dangerous symptoms

Persistent excruciating pain aggravated by physical stress, instability, joint loosening, tendency to subluxation, dislocation, and ligament damage are dangerous symptoms that require a visit to the doctor. The ankle changes from the outside: it takes a different shape due to the multiplied osteophytes. Osteoarthritis of the ankle leads to its thickening. The movements of the foot are at first somewhat limited, and then the ankle becomes motionless or, conversely, loose and unstable. However, at this stage, the patient can be helped, just go to the clinic. Symptoms of osteoarthritis of the foot appear: pain in the foot, impaired flexion and wear. The development of osteoarthritis of the big toe is accompanied by pain and deformity in the form of bulging and bending of the big toe.

What is dangerous arthrosis of the ankle?

The danger is that the disease initially develops invisibly, and often the patient sees a doctor at an advanced stage.

Any localization and form of osteoarthritis has serious complications, so you should not delay treatment.

Classification

Osteoarthritis of the ankle can be primary or secondary due to a known origin, if the cause of its development is not determined. Depending on the cause of the development, the disease may have its own characteristics.

Post-traumatic arthrosis 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 hernia, dislocation, intraarticular fracture. Usually one joint is injured, so post-traumatic osteoarthritis is unilateral. A small but untreated injury may not be felt at first. And only after a while, when a person forgets to do it already, a slight increasing pain appears. This type of injury is dangerous because the patient is already in a state of neglect. Serious injuries are better treated, their results appear more quickly, and the patient sees a doctor not too late.

Invisible long-term microtrauma of both ankles is characteristic of professional dancers, athletes, and people whose profession involves staying on their feet for long periods of time. There is symmetrical pain in the ankles during physical exertion. They are often confused with muscle pain along with fatigue, so it is too late to see a doctor.

Osteoarthritis of the ankle after arthritis

The causes of this osteoarthritis can be chronic inflammatory processes in the joints (arthritis): rheumatoid, reactive, psoriatic. In this case, inflammatory processes are associated with degenerative-dystrophic (arthritis-arthritis). This accelerates the process of ankle destruction. As the inflammation progresses, the joints become swollen, the skin on them becomes red, and the pain is especially severe at night. When inflammation is reduced, metabolic disorders predominate, all processes develop very quickly. The disease requires constant monitoring and treatment by a rheumatologist.

Less often, the degenerative-dystrophic process develops after suffering from acute purulent arthritis. The purulent process destroys the articular tissues, and after healing, connective tissue is formed in their place, which impairs the function of the joint.

Osteoarthritis can also occur after infectious arthritis - tuberculosis, gonorrhea, etc. The development of the disease is associated with the nature of the main infectious process and destruction. If the infection persists, the joint destruction will continue.

Metabolic

Gout develops with a long course. Very often the first finger is affected. Other small joints of the foot and ankle are less affected. As gout attacks continue, it is difficult to determine when the degenerative-dystrophic process has occurred. You can only see it on X-ray. In any case, the patient should be monitored regularly by a rheumatologist and examined periodically.

Deformative arthrosis of the ankle

All types of osteoarthritis deform over time. Bone deformities indicate an advanced stage of the disease when the cartilage has already collapsed and a constant mechanical impact on the bone tissue has helped it grow along the edges of the articular surface. This is how osteophytes change their articular 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. A little pain after standing or walking for a long time, a little stiffness in the morning. All this quickly disappears without any help. X-ray: normal or slight narrowing of the joint space.
2. progressive. After physical exertion, the pain becomes stronger and longer. The stiffness increases, a crisis appears in the joints during movement. Sometimes the joint is swollen, red and very painful - a sign of synovitis. X-rays show a significant narrowing of the joint space, thickening of the cartilaginous bone tissue (osteosclerosis) and an increase in osteophytes.
3. Final. The pain syndrome intensifies and becomes permanent. Due to the pain, the person limps, bends his legs, uses a cane or crutch. The function of the limb is impaired, arthrosis of the foot and big toe develops. Incomplete flexion-extensor movements are rare, usually against the background of osteoarthritis. On X-ray: no joint space, osteosclerosis, large osteophytes deforming the joint.

Possible complications

If the disease is not treated and everything is not allowed to go its own way, the following complications are possible:

• persistent joint and disability dysfunction;
• severe persistent pain in the ankles and feet, both after exercise and already;
• ankle instability with the development of normal dislocations and subluxations;
• Injuries to the foot and thumb will combine, which will further aggravate the patient's condition.

Diagnosis of ankle arthrosis

Before prescribing treatment, the doctor examines the patient, including:

• medical interview and examination;
• Additional research methods: laboratory tests (signs of inflammation and metabolic disorders are detected), instrumental studies (radiography of the joint in two projections, computed tomography and magnetic resonance imaging - early changes in bone structures and soft tissues), diagnostic arthroscopy examines the inner joint surface).

Treatment of arthrosis of the ankle joint

After making the final diagnosis, the doctor selects an individual treatment complex for the patient, consisting of medicinal and non-pharmacological methods.

Medical treatment of osteoarthritis of the ankle joint

Drugs with symptomatic (eliminates the symptoms of the disease) and pathogenetic (suppresses the mechanism of disease development) are prescribed.

Anti-inflammatory and analgesics

Non-steroidal anti-inflammatory drugs (NSAIDs) are prescribed in short courses to relieve pain and relieve pain and inflammation (if synovitis worsens):

• injection;
• rectal suppositories;
• oral tablets;
• skin patch.

Muscle relaxants

The muscles that surround the patient's joint and perform its movements are under constant tension, which leads to their atrophy and increased pain. Medications from the muscle relaxant group are prescribed to relieve muscle spasms.

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 regeneration. They are prescribed in the form of injections, tablets and external agents (creams and ointments).

Hyaluronic acid preparations for arthrosis of the ankle joint

Hyaluronic acid is injected into the joint cavity to improve the buffering capacity of synovial fluid and prevent further damage to cartilage and bone tissue. This relieves pain and increases joint mobility.

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

External means can be used at home. Ointments for osteoarthritis of the ankle joint:

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

Non-drug therapy

The main methods of treatment of ankle osteoarthritis are drug-free. These are therapeutic exercises, massage, physiotherapy, installation of orthopedic devices.

Physiotherapy

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

• electrophoresis with drugs;
• laser therapy;
• magnetotherapy;
• warming procedures - paraffin, ozocerite, in spa conditions - mud applications.

Massage for arthrosis of the ankle joint

Massage courses improve blood circulation, which leads to the activation of metabolism and the regeneration of joint and extraarticular tissues. The positive effect of massage on the muscles is to eliminate the spasm that helps blood flow to the muscles and restore the strength needed to keep the joint in the desired position.

Exercises and exercise therapy for ankle arthrosis

Therapeutic gymnastics is a panacea for osteoarthritis. Physical activity is very important, and in addition to exercise therapy, swimming is also beneficial. Systematic exercise, selected by a doctor, allows you to greatly restore the function of the joint, even with an advanced disease.

Approximate set of exercises (but you should consult your doctor before starting to exercise):

Use of special orthopedic products

To prevent the development of the disease, the doctor may prescribe a special orthopedic device - an orthosis. Corrects the foot in the correct anatomical position, relieves muscle tension, improves blood circulation. The orthosis is prescribed by a doctor, who also chooses the most suitable model.

Ankle fixation can also be done using tape: the ankle is gently secured in the desired position with special adhesive tapes.

Surgical intervention

Surgery is recommended for severe pain that cannot be eliminated by conservative treatment, as well as for significant joint dysfunction.

Types of surgical interventions

Operations can be performed in traditional and gentle ways:

1. Therapeutic arthroscopy (careful operations):
   • Sanitation of the articular cavity - with the help of an arthroscope, pieces of cartilage and bone tissue that impede movement and cause pain are removed from the cavity;
   • chondroplasty - removal of the damaged cartilage layer, which stimulates the growth of new cartilage cells (abrasive chondroplasty); in some cases, transplantation of autoimmune parts taken from unloaded areas 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.
2. Arthrodesis is a traditional surgery. This is done with significant dysfunction of the joint, its loosening, normal dislocation and pain. The joint is removed, and the bones of the lower leg are joined to the bones of the foot. The ankle becomes immobile and serves only as a support.
3. Endoprosthesis is the artificial replacement of an outdated and lost function of the heel.

Features of postoperative rehabilitation

All operations are performed in an inpatient setting, after which experts recommend a full rehabilitation. Rehabilitation with careful operations is carried out in an outpatient setting with early inclusion in the course of therapeutic exercises, except for high loads on the joint. After endoprosthesis, the patient stays in the hospital for a week, after which rehabilitation measures are carried out in an outpatient setting. After two weeks, the stitches are removed and the patient can take a shower.

Dietary food

There is no specific diet for osteoarthritis. However, it is necessary to maintain a normal body weight to eliminate unnecessary stress on the ankle. A person should get a proper healthy diet, but the amount of high-calorie foods should be partially replaced by vegetables and fruits. Low-fat first and second courses, chicken, seafood, cottage cheese, cheese, dairy products are useful.

Traditional medicine

Using only traditional medicine for osteoarthritis will not help. However, 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; 20 g of finely chopped grass is poured into a thermos with 500 ml of boiling water overnight, filtered in the morning and taken half a glass 4 times a day for a month; analgesic, which restores cartilage tissue;
• for oral administration: in the morning take a mummy ball with a diameter of 0. 5 cm, chew thoroughly, 30 minutes before meals for 10 days; Take a break for 5 days, then repeat everything 3 more times; excellent stimulator of metabolic processes;
• honey massage: before going to bed, apply warm liquid honey to the ankle and gently massage the tissues for 5 minutes; then wrap your feet in a warm shawl and leave until the morning; restores blood circulation and metabolism in cartilage tissue.

Approach to treatment in clinics

Clinicians have developed their own approaches to treating diseases such as ankle and foot arthrosis. At the initial admission, the patient is thoroughly examined, the doctor carefully listens to his complaints and medical history, and then prescribes additional laboratory and instrumental studies, including MRI. Only then does the doctor make the final diagnosis, make an appointment and agree with the patient on a comprehensive treatment. It consists of:

• modern schemes of drug and non-drug treatment of osteoarthritis - drugs, physiotherapy, exercise therapy and massage, methods of ankle fixation;
• Traditional methods of oriental therapy - acupuncture, moxibustion, acupressure, taping, including various methods of kinesiotherapy.

These are not all methods used in clinics. Doctors are able to combine Western and Eastern methods, significantly accelerating the improvement of the patient's condition. Patients get rid of pain quickly, quality of life improves significantly.

Proven techniques of the East and innovative methods of Western medicine.

Prevention of osteoarthritis of the foot

The following recommendations should be followed to reduce the risk of developing the disease:

• activities, exercise therapy exercises, swimming should become a part of your life;
• high physical activity and any traumatic factors should be excluded; walking should be combined with rest, if the legs are injured during work, it is worth replacing it;
• injuries on the ice, especially in winter, should be ruled out by thinking about the roads and the shoes used;
• Rational nutrition is needed to restore metabolism, but excess weight is an additional burden on the ankle, get rid of it;
• Preventive treatment courses ensure a painless life.

Frequently asked questions about the disease

1. Which doctor should I see for arthrosis of the ankle joint and arthrosis of the foot?

   Orthopedist-traumatologist. However, if the disease develops against the background of some kind of rheumatic process, consult a rheumatologist.

2. What predictions do doctors usually make?

   It is possible to stop the progression of the degenerative process at any stage and improve the quality of life, but it is better to do it at the beginning of the disease, do not wait for the appearance of complications.

3. Can ankle arthritis develop in children?

   Maybe after an injury or against the background of congenital pathology.

4. What are the consequences of the disease?

   Untreated osteoarthritis leads to disability. If you start treatment on time, it is quite possible to maintain the function of the joint. In the later stages, treatment will eliminate pain and improve quality of life.

5. Are sports injuries the cause of ankle osteoarthritis?

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

6. Is it possible to stick to the ankle with osteoarthritis?

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

Osteoarthritis of the ankle is almost always the result of macro or microtrauma. At first it continues slowly and invisibly. Therefore, timely treatment and rehabilitation after injuries, it is very important to consult a doctor at the first signs of ankle disease.