Osteoarthritis of the ankle is a degenerative, dystrophic disease of the structures of the musculoskeletal system. Affects the lower extremities. It is considered one of the most common forms of osteoarthritis: it accounts for up to 30% of all degenerative-dystrophic joint damage. The pathological process occurs not only in older patients. About a quarter of patients are people under 40 years of age.
The disorder is accompanied by persistent pain and a gradual deterioration in the function of the joint and lower extremity. Without treatment, the disease progresses and does not go away on its own. The diagnosis and treatment of the disorder is the responsibility of an orthopedic doctor (depending on the cause, a traumatologist and physiotherapists and physiotherapists are involved).
Causes of ankle osteoarthritis
Osteoarthritis is considered a polyetiological disease. Its development occurs through the influence of a group of causes. With increasing age, the number of factors that trigger the disease increases and with it the likelihood of a pathological process. But not everything is that simple.
Pathogenesis of the disorder
There are a group of causes of ankle osteoarthritis, the most common of which include:
- 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 choice. 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 injury, especially intra-articular fractures, dislocations and also severe bruising (to a lesser extent). Osteoarthritis of the ankle manifests itself unnoticed but progresses steadily. Patients often underestimate the consequences of the trauma they have suffered.
Surgery can cause osteoarthritis. However, such a complication is relatively rare. Mainly due to incorrect assessment of the clinical situation. insufficient qualifications of the doctor.
Metabolic diseases such as diabetes mellitus can cause a disorder. However, gout and hormonal disorders (e. g. during menopause) are much more common causes of ankle osteoarthritis.
Uncomfortable footwear is one of the key factors in the development of the pathological process. The problem occurs due to incorrect load distribution on the foot. Complex diseases usually develop: not only arthrosis, but also spinal injuries. At least osteochondrosis. But more dangerous problems are also possible.
The dysfunctions of the musculoskeletal system themselves also increase the likelihood of a pathological process. Additional risks arise from intervertebral hernias, osteochondrosis and congenital diseases.
Rheumatoid diseases are represented by arthritis and systemic lupus erythematosus. Degenerative-dystrophic lesions are secondary, but aggravate the underlying disease and worsen the prognosis.
Osteoarthritis of the ankle is a multifactorial disease. As a rule, it arises under the influence of several causes at the same time. There are exceptions, but they are rare. Also, the number of factors influences the severity of the disease and the progression of the pathological process.
The development of the pathological process occurs gradually. In the initial stage, the local blood circulation and the dynamic distribution of load on the foot are disturbed. Destructive processes in the cartilage gradually occur. A sluggish inflammation begins. Degeneration of other structures of the ankle joint occurs: capsule, ligaments, bones, etc. The more advanced the disease, the more difficult it is to treat. It requires more effort and time.
Factors of increased risk of osteoarthritis
Dystrophic destruction of the tissues of the ankle joint occurs not only due to the influence of immediate causes. The severity, likelihood of the disease and the nature of its course are influenced by risk factors. They complete the picture of the violation. Including:
- habit of wearing heels;
- the physically difficult nature of the work (including jobs with non-obvious risks: teachers and cooks also get sick);
- previous injuries to the ankle joint (there are cases when the disease manifested itself years after the injury);
- History of endocrine disorders (hormonal imbalances pose additional risks);
- history of musculoskeletal disorders;
- Age 40+ (although the disease also occurs in younger people);
- increased body weight;
- Gender (women suffer more often than men).
Osteoarthritis of the ankle is a disease that develops slowly and the symptoms are not immediately visible. Therefore, it is difficult to assess which risk factors and causes trigger the pathological process. It is necessary to obtain a complete medical history.
Classification and type of damage to the ankle joint
Pathology is classified according to two bases.
The first criterion is the origin of the pathological process. To mark:
- post-traumatic form of the disease (arises after injuries to the ankle joint or other structures of the musculoskeletal system);
- deforming arthrosis of the ankle joint: result of metabolic disorders or injuries, accompanied by slow but steady deformation of the joint;
- Metabolic osteoarthritis occurs against the background of diabetes, hormonal disorders or gout (purine metabolism disorders).
The second basis for classification is based on the stage of the pathological process. In its development, osteoarthritis of the ankle goes through the following stages:
- initially or early;
- progressive;
- advanced osteoarthritis.
In the first stage, there is no clinical picture or it occurs after intense physical activity. The pathological process is detected only with the help of special diagnostic methods.
The progressive phase of the disease is accompanied by an intensification of the clinical symptoms. Symptoms occur after light physical activity. Exercise tolerance decreases. There is a constant pain syndrome and limited mobility of the leg in the ankle joint.
The final stage of the pathological process is accompanied by severe pain, as well as other symptoms in a state of complete rest. Both support and motor skills are impaired. Often a person becomes disabled. Complex surgical treatment, including endoprosthetics, is required.
Important!
Staging plays the largest role in determining treatment tactics and predicting the course and outcome of the disease. The disorder is best treated at an early stage. The more advanced the pathology, the more difficult and time-consuming it is to correct.
Symptoms of the disorder
The clinical picture depends on the form and stage of the pathological process. Typical manifestations are:
- Pain;
- Fatigue;
- exercise intolerance;
- Swelling;
- Disturbances in the supporting function of the leg;
- Muscle weakness.
Pain in the leg is initially only observed after intensive physical activity. Then a little activity is enough. In the advanced stage of the pathological process, pain is always present, regardless of the load.
Fatigue is observed from the first stage of the disease. The feeling of muscle weakness and increased fatigue progresses as the disease progresses. Signs point to further development of the disorder.
Exercise tolerance also gradually decreases. In a 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 present. The leg at the ankle looks swollen and enlarged. This is a nonspecific manifestation.
Initial pain is typical. After staying in one place for a long time, the joint becomes very stiff. 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. Plays a huge role in determining the stage and severity of the pathological process. The doctor systematizes the symptoms through oral questioning and taking an anamnesis.
The disease is characterized by a chronic course. During periods of exacerbation, the signs of ankle osteoarthritis are most noticeable. In the chronic phase the remission is only partial. The clinic is not so bright, but the symptoms do not disappear completely. Then the osteoarthritis of the ankle worsens again and the symptoms become more intense again. And so on in circles until quality treatment is provided.
Complications of ankle arthrosis
Complications of the pathological process relate to maintaining the ability to work and the ability to care for oneself.
Patients experience ankle deformities. The pathological process ends with the formation of contractures, areas of primary or complete immobility of the limb in the ankle joint. The situation can only be corrected surgically.
At the time of exacerbation, the development of synovitis and inflammation of the bursa is typical. This condition lasts several weeks and, in the acute course, leads to a complete loss of the ability to work and move.
The end result of the pathological process is a decrease and then a complete loss of the supporting function of the leg; the person cannot move normally. You have to use crutches. There is a complete loss of the ability to work and, in some cases, the ability to care for oneself. In the advanced stage of ankle osteoarthritis, the patient becomes disabled.
Diagnosis of the disease
Diagnosis of damage to joint structures and cartilage tissue is carried out under the supervision of an orthopedic traumatologist. The examinations are typical. It is not difficult to identify the pathological process, as well as the degree of severity. About the techniques:
- Oral questioning of the patient to better understand the nature of the symptoms and health complaints;
- Collecting an anamnesis that allows you to determine the probable origin of the pathological condition;
- Palpation: Osteoarthritis is indicated by deformity, swelling and pain with passive movements.
- Ankle X-ray: A routine examination that provides sufficient information to make a diagnosis and determine severity is considered the gold standard examination;
- MRI if the X-ray data is insufficient.
Further studies can be carried out. For example, computed tomography (arthrosis affects not only cartilage, but also bones; CT allows detailed and accurate visualization of the nature of the diseases).
Take note!
Osteoarthritis does not have any specific manifestations, especially in the early stages. Without sufficient knowledge, it is therefore not possible to distinguish pathological processes from one another. Special instrumental diagnostics is required.
Laboratory diagnostic procedures provide only limited data. They are only informative in terms of identifying the inflammatory process and help diagnose some forms of arthrosis (metabolic origin, rheumatoid nature).
Treatment methods
Treatment of ankle arthrosis is carried out using conservative and surgical techniques. The best results can be achieved when resorting to complex corrections.
Conservative therapy includes the use of medications, exercise therapy and physiotherapy with massage. The following medications are used:
- local anti-inflammatory;
- general anti-inflammatory drugs (in the form of tablets or solutions for injection);
- chondroprotectors;
- Nicotinic acid and other means to improve metabolic processes.
Exercise therapy and physiotherapy, together with massage, are aimed at recovery after eliminating the acute illness. These methods are important during the remission phase. If the disease occurs in an acute form with pronounced clinical symptoms, the methods are postponed.
In case of deformities and persistent deviations in the anatomy of the joint, surgical treatment is required. Joint plastic surgery or endoprosthetics, joint replacement with an artificial analogue are possible. This is a high-tech correction method.
Forecasts
The prognosis depends on the timing of treatment, the state of health, the cause of osteoarthritis and the degree of development of the disease. The more advanced the disease is, the more complicated the situation is. If treatment begins early, the prospects for healing and complete recovery are good. In other cases, surgery and a long rehabilitation period are required.
Prevention of the disorder
Prevention of ankle osteoarthritis includes:
- wear comfortable shoes;
- timely treatment of diseases of the musculoskeletal system;
- adequate monitoring of well-being;
- control of body weight;
- preventing injuries;
- Load control.
Prevention can reduce the risk of ankle osteoarthritis by 2 to 3 times. The likelihood of a pathological process will be minimal.