Ankle arthritis is a chronic disease that affects the articular cartilage and subsequently other structures of the joint (capsule, synovium, bones, ligaments). It has degenerative-dystrophic properties. It is manifested by pain and limitation of movement, followed by progressive deterioration of support and ambulatory functions. The diagnosis is made based on symptoms, examination and X-rays. Treatment is typically conservative, using anti-inflammatory drugs, chondroprotectors, and glucocorticoids, and prescribing exercise therapy and physical therapy. In severe cases, hygienic arthroscopy, arthroscopy or arthroscopy is performed.
General information
Ankle arthritis is a disease in which joint cartilage and surrounding tissues are gradually destroyed. The disease is based on a degenerative-dystrophic process, arthritis is secondary. Arthritis has a chronic, wave-like course with alternating remissions and exacerbations and gradually progressing. Women and men often suffer equally. The ability to develop increases dramatically with age. At the same time, experts note that the disease is "rejuvenating" - every third case of ankle arthritis is now detected in people under 45 years of age.
reason
Primary arthritis occurs for no apparent reason. Secondary damage to the ankle joint develops under the influence of a number of adverse factors. In both cases, the cause is a violation of metabolic processes in cartilage tissue. The main causes and favorable factors for the formation of secondary osteoarthritis in the ankle joint are:
- major trauma within and around the joint (talar bone fractures, ankle fractures, ligament tears and ruptures);
- ankle surgery;
- excessive load: playing intense sports, long walks or constant standing due to working conditions;
- wearing high heels, being overweight, constant micro-trauma;
- diseases and conditions associated with metabolic disorders (diabetes mellitus, gout, pseudogout, estrogen deficiency in postmenopause);
- rheumatic diseases (SLE, rheumatoid arthritis);
- Osteoarthritis of the lumbar spine, intervertebral herniation and other conditions accompanied by pinched nerves and disruption of the muscular system of the feet and legs.
Less commonly, causes of joint disease are nonspecific purulent arthritis, arthritis due to specific infections (tuberculosis, syphilis), and congenital developmental defects. Unfavorable environmental conditions and genetic predisposition play a certain role in the development of arthritis.
Pathogenesis
Normally, joint surfaces are smooth, elastic, slide smoothly against each other during movement, and provide effective shock absorption under load. Due to mechanical damage (trauma) or metabolic disorders, cartilage loses its smoothness, becomes rough and less elastic. Cartilage rubs against each other during movement and damages each other, leading to increasingly severe pathological changes.
Due to insufficient depreciation, excess load is transferred to the underlying bone structure, and degenerative-dystrophic disorders also develop in it: bones are deformed and grow along the edges of the joint area. Due to secondary trauma and disruption of the normal biomechanics of the joint, not only the cartilage and bone but also the surrounding tissues are affected.
The joint capsule and synovial membrane thicken, and fibrous degeneration foci form in the ligaments and muscles around the joint. The joint's ability to engage in movement and load is reduced. Instability occurs and pain progresses. In severe cases, the joint surface is destroyed, the support function of the limb is impaired and movement is impossible.
Symptom
Initially, rapid fatigue and mild pain in the ankle joint are detected after a significant load. After that, the pain syndrome becomes more intense, its nature and duration of appearance change. Outstanding features of pain caused by arthritis are:
- Starts to hurt. Appears after a state of rest and then gradually disappears during movement.
- Load dependence. The pain increases with exercise (standing, walking) and the joint fatigues quickly.
- Night pain. Usually appears in the morning.
The condition varies from episode to episode, during an exacerbation the symptoms are more pronounced, in the first period of remission they disappear, then become less intense. There is a gradual progression of symptoms over several years or decades. Along with pain, the following manifestations are identified:
- When moving, crunching, squeaking or clicking sounds may occur.
- During an exacerbation, the area around the joint sometimes swells and turns red.
- Due to joint instability, patients often twist their legs, causing sprains and torn ligaments.
- Stiffness and restriction of movements are noted.
symptoms
During an exacerbation, reactive synovitis may occur, accompanied by fluid accumulation in the joint. At a later stage, obvious deformation is revealed. Movements are significantly limited and spasms develop. Support becomes difficult, and when moving, the patient is forced to use crutches or a cane. There is a decline or loss of ability to work.
Diagnose
Diagnosis of ankle joint arthritis is made by an orthopedist based on a survey, external examination data and the results of additional studies. When examined at an early stage, there may be no changes, but later deformities, limited movement and pain when palpated will appear. Primary importance is given to visualization techniques:
- X-ray of the ankle joint. Plays a decisive role in diagnosing and determining the level of osteoarthritis. Pathology is manifested by a narrowing of the joint space, proliferation of the edges of the joint surface (osteoporosis). In later stages, cyst formation and osteosclerosis in the subchondral (under the cartilage) area of the bone are detected.
- Tomographic study. Used when indicated. In difficult cases, to more accurately assess the condition of the bone structure, the patient is also sent for a computed tomography scan and examination of soft tissues - an MRI scan of the ankle joint.
Laboratory tests remained unchanged. If necessary, to determine the cause of arthropathy and differential diagnosis with other diseases, it is necessary to consult relevant specialists: neurologist, rheumatologist, endocrinologist.
Treatment of ankle arthritis
Treatment of long-term and complex pathologies. Patients are typically seen on an outpatient basis by an orthopedic surgeon. During exacerbation, hospitalization in the trauma and orthopedic department is possible. The most important role in slowing the progression of joint disease is played by a proper lifestyle and physical activity regimen, therefore the patient is given recommendations to lose weight and optimize the load on the legs.
Drug treatment
It is selected individually, taking into account the stage of arthritis, severity of symptoms and accompanying diseases. Includes general and local dealers. The following groups of drugs are used:
- Generic NSAIDs. Usually tablet forms are used. Medicines have a negative effect on the stomach lining, so for gastrointestinal diseases, priority should be given to using "gentle" medicines.
- Local NSAIDs. Recommended both during exacerbation and during remission. An alternative may be prescribed if side effects occur from the tablet form. Available in ointment and gel form.
- Chondroprotectors. Substances that help normalize metabolic processes in cartilage tissue. They are used in the form of creams, gels and preparations for injection into the joints. Use medications containing glucosamine and hydrolyzed collagen.
- Hormonal agents. In cases of severe pain that cannot be relieved by medication, intra-articular corticosteroids are injected no more than 4 times a year.
- Metabolic stimulant. To improve local blood circulation and activate tissue metabolism, nicotinic acid is prescribed.
Physical therapy treatment
The patient is prescribed a complex physiotherapy regimen, which is developed taking into account the manifestations and stages of the disease. The patient was referred to physical therapy. In the treatment of arthritis, massage and UHF are used. In addition, in the treatment of pathologies they use:
- laser therapy;
- thermal procedures;
- Medical electrophoresis and ultrasound.
Surgery
Indicated in the later stages of the disease when conservative therapy is ineffective, the pain syndrome is severe, the patient's quality of life is impaired or the ability to work is limited. Operations performed in a hospital setting, open and minimally invasive:
- Arthroscopic intervention. If the cartilage is significantly destroyed, arthroscopic meniscus surgery will be performed. Sanitary arthroscopy (removal of components that impede movement) is often performed for severe pain in stage 2 joint disease. The effect lasts for several years.
- Osteoarthritis of the ankle joint. It is performed in cases of significant destruction of the joint surface, involving removal of the joint and "fusion" of the bones of the foot and lower leg. Provides restoration of limb support function in case of loss of joint mobility.
- Ankle arthroscopy. Made for advanced arthritis. Involves removing the destroyed joint surfaces of bones and replacing them with plastic, ceramic, or metal prostheses. Movements are completely restored, the lifespan of the prosthesis is 20-25 years.
Forecast
Changes in the joints are irreversible, but slow progression of joint disease, timely initiation of treatment and compliance with the recommendations of the orthopedic traumatologist in most cases help to preserve the abilitywork and high quality of life for decades after its appearance. of the first symptoms. With the rapid increase in pathological changes, endoscopy allows people to avoid disability.
Prevent
Preventive measures include reducing the severity of injuries, especially in winter, during times of frost. If you are obese, you need to take measures to reduce body weight to reduce the load on your joints. You should maintain a moderate physical activity regimen, avoid overload and micro-trauma, and promptly treat diseases that can cause ankle osteoarthritis.