In recent years, experts around the world have noted an increase in degenerative-dystrophic processes in the ankle, gradually leading to disability. Osteoarthritis of the ankle often develops as a result of serious injuries or permanent microtraumas in athletes, professional dancers, circus performers. How to recognize the signs of this disease in time and stop its progression, as well as how to treat it, we will tell in this article.
Osteoarthritis of the ankle - what is it?
The ankle is a complex block-like joint formed from the inferior (distal) ends of the tibia and fibula of the lower leg, forming the inner and outer ankles (ankles) and 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 to the foot, sharing ligaments and muscle tendons with the joints of the foot.
Arthrosis of the ankle is a degenerative-dystrophic disease that begins with the thinning and destruction of articular cartilage, reducing its depreciation properties, followed by the involvement of all other joint tissues in the pathological process. The disease gradually leads to complete wear and tear of the joint and disability. The code for osteoarthritis of the ankle ICD-10 is M19.
The condition is less common than a similar knee injury and is usually the result of serious injury or long-term injury as a result of activity.
Causes of osteoarthritis of the ankle
Specialists have studied in detail the reasons for the development of arthrosis of the ankle and arthrosis of the foot. The:
- Injuries - intra-articular fractures of the joints, fractures of the ankles, complete and incomplete tears 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 high-heeled shoes;
- Metabolic disorders that negatively affect the metabolism in cartilage tissue - diabetes mellitus, obesity, gout, etc . ;
- hormonal, including age-related changes;
- transferred severe acute suppurative arthritis;
- long-term chronic arthritis of any origin;
- Osteochondrosis of the lumbar spine and intervertebral hernia causing injury to the roots of the spine and weakening of the muscles of the lower leg and feet, leading to joint instability and injuries.
Mechanism of disease development (pathogenesis)
Under the influence of various reasons, blood circulation in the joint region is disturbed, which leads to a decrease in the volume of synovial fluid that nourishes the cartilage tissue. Due to the lack of oxygen and nutrients, the cartilage becomes thinner, cracks and erosion appear. This leads to injury to the subcartilage layer of the bone. It thickens (scleroses) and grows along the edges of the articular surfaces. These growths are called osteophytes. They compress soft tissues, blood vessels, and nerves, causing pain and further disrupting blood flow.
The muscles suffer from circulatory disorders and high tension, they become weak, which leads to joint instability and frequent dislocations. Osteoarthritis of the foot develops, small joints of the tarsal, metatarsal-tarsal, metatarsophalangeal and interphalangeal joints are affected.
Connective tissue gradually grows in the joints, tightening the joint surfaces and interfering with joint function. The complete loss of function of the ankle is associated with the fusion of the bone joints. Osteoarthritis of the foot also develops gradually.
Symptoms of osteoarthritis of the ankle
Osteoarthritis of the ankle initially progresses slowly and imperceptibly. But the symptoms gradually appear and increase, indicating some kind of injury to the lower limb.
First signs
The very first symptom of arthrosis of the ankle is pain during high loads, for example, long walks, 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. Pain can occur both symmetrically in both joints (with high loads and microtraumas) and unilaterally (after a serious injury).
Then there is a feeling of stiffness in the morning or after a long stay in a motionless state. The ankles become stiff for a while, making movement difficult. It lasts a few minutes at the initial stage and passes at a slow pace. This symptom should already alarm and become the reason for a visit to the doctor.
Obvious Symptoms
Gradually, after exertion, the pain intensifies and lasts longer. The leg can ache all day. Night pains are added, they usually appear in the second half of the night and are sometimes accompanied by painful muscle cramps. Times of stiffness after immobility are also prolonged.
Due to severe pain, a person begins to limp when walking and tries to relieve pain in the foot by stretching or pressing. Sometimes the ankle swells, the skin over it turns red, the pain intensifies. This is a sign of synovitis - inflammation of the inner synovial membrane. Inflammation is non-infectious in nature, develops from mechanical irritation, and resolves on its own without treatment. At the same time, the exacerbation of synovitis activates the progression of the articular degenerative-dystrophic process.
Dangerous Symptoms
Constant pain, aggravated by physical exertion, instability, looseness of the joint, a tendency to subluxation, dislocation and ligament injuries are dangerous symptoms that require a visit to the doctor. Externally, the ankle changes: it takes on a different shape due to ingrown osteophytes. Osteoarthritis of the ankle (ankle) leads to its thickening. Movements in the foot are slightly limited at first, then the ankle becomes motionless, 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 devaluation. The development of osteoarthritis of the big toe is accompanied by pain and foot malpositions in the form of bulging and outward bending of the big toe.
What is dangerous arthrosis of the ankle?
The danger is that at first the disease develops imperceptibly and very often the patient goes to the doctor at an advanced stage.
Each localization and form of arthrosis has serious complications, so you should not delay treatment.
classification
Osteoarthritis of the ankle can be primary, when the cause of its development is not clear, and secondary, with a known cause. Depending on the cause of development, the disease may have its own specifics.
Post-traumatic arthrosis of the ankle
The consequences of traumatic injuries are the most common cause of the disease. Post-traumatic arthrosis of the ankle can develop after a serious injury - ligament rupture, dislocation, intra-articular fracture. Usually one joint is injured, so the post-traumatic arthrosis is unilateral. A small but untreated injury may not show itself at first. And only after a while, when a person has already forgotten about it, a slightly growing pain appears. This type of injury is dangerous, since the patient goes to the doctor already neglected. Serious injuries are better treated, their consequences appear faster, and the patient does not seek medical help so late.
An inconspicuous long-term microtrauma of both ankles is typical for professional dancers, athletes and people whose profession involves standing for a long time. With physical exertion, symmetrical pains appear in the ankles. It's usually mistaken for muscle pain with fatigue, so it's too late to see a doctor.
Osteoarthritis of the ankle after osteoarthritis
The causes of this arthrosis 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 hock. With an exacerbation of inflammation, the joints swell, the skin over them turns red, the pain becomes very strong, especially at night. When the inflammation subsides, metabolic disorders predominate, while all processes develop very quickly. The disease requires constant monitoring and treatment by a rheumatologist.
Much less often, the degenerative-dystrophic process develops after acute purulent arthritis. The purulent process destroys the joint tissue, and after recovery, connective tissue forms in its place, which disrupts the functioning of the limb.
Osteoarthritis 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 its destruction. If the infection persists, joint destruction progresses.
metabolism
Develops with a long course of gout. Very often the first toe is affected. Other small joints of the foot and ankle are less commonly affected. Since the attacks of gout are ongoing, it is difficult to determine externally when the degenerative-dystrophic process occurs. You can only see that on an X-ray. In any case, the patient should be regularly observed by a rheumatologist and periodically examined.
Deforming 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 the constant mechanical impact on the bone tissue contributes to its growth at the edges of the articular surface. This is how osteophytes develop, which change the shape of the joint.
Degree of osteoarthritis of the ankle
There are several classifications, one of which distinguishes three clinical and radiological stages of osteoarthritis:
- Early. A little pain after standing or walking for a long time, some stiffness in the morning. All this quickly disappears without help. X-ray: normal or slight narrowing of the joint space.
- progressive. Pain after physical exertion is stronger and longer. Stiffness increases, during movement there is a crunch in the joints. Sometimes the joint swells, reddens and hurts badly - a sign of synovitis. The X-ray shows a clear narrowing of the joint space, thickening of the subcartilage bone tissue (osteosclerosis) and proliferation of osteophytes.
- final. The pain syndrome intensifies, becomes permanent. Because of the pain, a person hobbles, tucks his feet in, uses a cane or crutches. The function of the limb is impaired, arthrosis of the foot and thumb develops. The complete absence of flexion-extensor movements is rare, most often against the background of osteoarthritis. On the X-ray: there is no joint space, osteosclerosis, large osteophytes deforming the joint.
Possible complications
If the disease is not treated and everything takes its course, then the following complications are possible:
- persistent joint dysfunction and disability;
- severe incessant pain in ankle and feet, both after exertion and without;
- instability of the ankle with the development of habitual dislocations and subluxations;
- Damage to the foot and thumb will be added, further aggravating the patient's condition.
Diagnosis of osteoarthritis of the ankle
Before prescribing treatment, the doctor conducts an examination of the patient, including:
- medical interview and examination;
- additional examination methods: laboratory examinations (signs of inflammation and metabolic disorders are detected), instrumental examinations (X-ray of the joint in two projections, computer and magnetic resonance imaging - early changes in bone structures and soft tissues are detected), diagnostic arthroscopy (the inner articular surface is examined ).
Treatment of osteoarthritis of the ankle
After establishing the final diagnosis, the doctor selects for the patient an individual complex of treatment from drug and non-drug methods.
Medical treatment of osteoarthritis of the ankle
Drugs are prescribed that have a symptomatic (eliminates the symptoms of the disease) and pathogenetic (suppresses the mechanism of the development of the disease) action.
Anti-inflammatory and analgesic agents
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 under constant tension, which leads to their atrophy and increases pain. To eliminate muscle spasms, drugs from the group of muscle relaxants are prescribed.
chondroprotectors
Medicines 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 osteoarthritis of the ankle
In order to improve the cushioning ability of the synovial fluid and prevent further injuries to the cartilage and bone tissue, hyaluronic acid is injected into the joint cavity. This leads to pain relief and improved joint mobility.
Antiarthrosis gels and ointments for osteoarthritis of the ankle
External funds can be used at home. Ointments for osteoarthritis of the ankle:
- NSAID gels are useful for reducing pain and inflammation;
- to restore cartilage - gel and ointment based on chondroitin.
Non-drug therapy
The main methods of treating osteoarthritis of the ankle are non-drug. These are therapeutic exercises, massage, physiotherapy, wearing orthopedic devices.
physical therapy
To alleviate the patient's condition and restore joint function, appoint:
- electrophoresis with drugs;
- laser therapy;
- magnetotherapy;
- Heating procedures - paraffin, ozokerite, in the conditions of spa resorts - mud applications.
Massage for osteoarthritis of the ankle
Massage courses improve blood circulation, which leads to activation of metabolism and restoration of articular and extra-articular tissues. The positive effect of massage on the muscles is the elimination of spasms, which contribute to blood circulation in the muscles, and the restoration of their strength, which is necessary to keep the limb in the desired position.
Exercise and movement therapy for arthrosis of the ankle
Remedial gymnastics is a panacea for arthrosis. Motor activity is very important, in addition to exercise therapy, swimming makes sense. The systematic implementation of the exercises selected by the doctor allows you to largely restore the function of the limb even with advanced disease.
An approximate set of exercises (but before you start implementing it, you need to consult your doctor):
Use of special orthopedic products
To prevent the progression of the disease, the doctor may prescribe wearing a special orthopedic device - an orthosis. It fixes the leg in the correct anatomical position, relieves muscle tension and improves blood circulation. Wearing an orthosis is prescribed by a doctor, who also chooses the most suitable model.
The ankle can also be fixed by taping: the ankle is gently fixed in the desired position with special adhesive tape.
Surgical intervention
The operation is recommended for severe pain that cannot be eliminated by conservative methods of treatment, as well as for significant functional disorders of the limb.
Types of surgical interventions
Operations can be performed in a traditional and gentle way:
- Therapeutic arthroscopy (gentle operations):
- sanitation of the articular 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 cartilage layer is removed, stimulating the growth of new cartilage cells (abrasive chondroplasty); in some cases, transplantation of autocartilage sections from unloaded areas of the patient's knee joint (mosaic arthroplasty) is performed; Chondroplasty is effective in the 2nd stage of the disease, when the joint has not yet lost its function.
- Arthrodesis is a traditional surgical procedure. It is performed with a significant violation of the function of the limb, its looseness, habitual dislocations and pain. The joint is removed, the bones of the lower leg are fused to the bones of the foot. The ankle becomes motionless and serves only as a support.
- Arthroplasty is the replacement of a worn and lost function of the ankle with an artificial one.
Features of rehabilitation after surgery
All operations are performed in stationary conditions, after which experts recommend full rehabilitation. In the case of gentle operations, rehabilitation is carried out on an outpatient basis with early involvement in therapeutic exercises, with the exception of high joint loads. After endoprosthetics, the patient stays in the hospital for a week, after which rehabilitation measures are carried out on an outpatient basis. After two weeks, the stitches are removed and the patient can take a shower.
Diet food
There is no special diet for osteoarthritis. However, in order to avoid unnecessary stress on the ankle, it is necessary to maintain a normal body weight. A person should receive adequate healthy nutrition, but the amount 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 alone for arthrosis does 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; Pour 20 g of finely chopped grass into a thermos with 500 ml of boiling water overnight, strain in the morning and take 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 30 minutes before meals for 10 days and chew thoroughly; Break 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 rub lightly for 5 minutes, massaging the tissues. then wrap the leg in a warm scarf and leave until morning; restores blood circulation and metabolism in cartilage tissue.
Treatment approach in clinics
Clinicians have developed their own approach to treating conditions such as osteoarthritis of the ankle and foot. During the first appointment, a thorough examination of the patient is carried out, the doctor carefully listens to his complaints and medical history, after which he prescribes additional laboratory and instrumental studies, including MRI. Only after this does the doctor make the final diagnosis, prescribe and agree with the patient on complex treatment. It consists of:
- modern schemes of drug and non-drug treatment of arthrosis - drugs, physiotherapy, exercise therapy and massage, methods of fixing the ankle;
- Traditional methods of oriental therapy - acupuncture, moxibustion, acupressure, various methods of kinesitherapy, including taping.
These are not all methods used in clinics. Doctors are able to combine Western and Eastern methods, which significantly accelerates the improvement of the patient's condition. Patients quickly get relief from pain, their quality of life improves significantly.
Combines proven techniques of the East and innovative methods of Western medicine.
Prevention of osteoarthritis of the foot
To reduce the risk of disease progression, the following recommendations should be followed:
- Activity, exercise therapy exercises, swimming should become part of your life;
- high physical activity and traumatic factors should be excluded; Hiking should be combined with rest. If the legs are injured during work, then it is worth changing them.
- Injuries, especially on ice in winter, should be ruled out by rethinking the types of movement and footwear used;
- Rational nutrition is necessary to restore metabolism, but being overweight is an additional burden on the ankle. Eliminate him.
- preventive treatment courses are a guarantee for a pain-free life.
Frequently asked questions about the disease
- Which doctor should I contact for osteoarthritis of the ankle and foot?
To the orthopedic traumatologist. But if the disease developed against the background of a rheumatic process, then to a rheumatologist.
- 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 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?
Perhaps after an injury or against the background of a congenital pathology.
- What are the consequences of the disease?
Untreated osteoarthritis leads to disability. If you start treatment on time, it is quite possible to preserve the function of the limb. Treatment in the later stages reduces pain and improves quality of life.
- Are sports injuries a cause of ankle osteoarthritis?
Yes, sports injuries are one of the main causes of this disease.
- Can you do a taping for osteoarthritis?
It is possible, but this should be done by a specialist.
Osteoarthritis of the ankle is almost always the result of macro or micro trauma. At first it proceeds slowly and imperceptibly. That is why timely treatment and rehabilitation after injuries is so important, as well as seeing a doctor at the first sign of ankle disease.