Osteoarthritis of the ankle joint is a chronic disease that affects the articular cartilage, then other structures of the joint (capsule, synovium, bones, ligaments). It has a degenerative-dystrophic character. It manifests itself by pain and limitation of movements, followed by a progressive impairment of weight-bearing and walking functions. The diagnosis is made on the basis of symptoms, examination and x-ray. Treatment is usually conservative, using anti-inflammatory drugs, chondroprotectors and glucocorticoids, and prescribing exercise therapy and physical therapy. In severe cases, sanitary arthroscopy, arthrodesis or endoprostheses are performed.
general informations
Ankle osteoarthritis is a disease in which the joint cartilage and surrounding tissues are gradually destroyed. The disease is based on degenerative-dystrophic processes, inflammation of the joint is secondary. Osteoarthritis has a chronic undulatory course with alternating remissions and exacerbations and progresses gradually. Women and men often suffer equally. The likelihood of development increases sharply with age. At the same time, experts note that the disease is "getting younger": one in three cases of ankle osteoarthritis is currently detected in people under 45 years old.
Causes
Primary osteoarthritis occurs for no apparent reason. Secondary damage to the ankle joint develops under the influence of certain adverse factors. In both cases, the basis is a violation of metabolic processes in cartilage tissue. The main causes and predisposing factors for the formation of secondary osteoarthritis of the ankle joint are:
- major intra- and periarticular injuries (talus fractures, ankle fractures, ligament tears and ruptures);
- ankle surgery;
- excessive load: too intense sports, long walking or constant standing due to working conditions;
- wearing high-heeled shoes, excess weight, constant microtrauma;
- diseases and conditions associated with metabolic disorders (diabetes mellitus, gout, pseudogout, estrogen deficiency after menopause);
- rheumatic diseases (SLE, rheumatoid arthritis);
- osteochondrosis of the lumbar spine, intervertebral hernia and other conditions accompanied by pinched nerves and disruptions in the muscular system of the foot and leg.
More rarely, the cause of osteoarthritis is nonspecific purulent arthritis, arthritis due to specific infections (tuberculosis, syphilis) and congenital developmental anomalies. Unfavorable environmental conditions and hereditary predisposition play a certain role in the development of osteoarthritis.
Pathogenesis
Normally, the joint surfaces are smooth, elastic, slide smoothly relative to each other during movements and provide effective shock absorption under load. As a result of mechanical damage (trauma) or metabolic disorders, cartilage loses its smoothness, becomes rough and inelastic. Cartilages "rub" during movements and become injured, which leads to aggravation of pathological changes.
Due to insufficient depreciation, excessive load is transferred to the underlying bone structure and degenerative-dystrophic disorders also develop there: the bone deforms and grows 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 bones suffer, but also the surrounding tissues.
The joint capsule and synovial membrane thicken, and foci of fibrous degeneration form in the ligaments and periarticular muscles. The joint's ability to participate in movements and resist loads decreases. Instability appears and the pain progresses. In severe cases, the joint surfaces are destroyed, the supporting function of the limb is impaired and movement becomes impossible.
Symptoms
Initially, rapid fatigue and slight pain in the ankle joint are detected after a significant load. Subsequently, the pain syndrome becomes more intense, its nature and time of appearance change. Distinctive features of pain associated with osteoarthritis are:
- Starting pain. Appear after a resting state, then gradually disappear with movement.
- Load dependence. There is an increase in pain during exercise (standing, walking) and rapid fatigue of the joint.
- Nocturnal pain. Usually appear in the morning.
The condition progresses in waves, during exacerbations the symptoms are more pronounced, in the remission phase they first disappear, then become less intense. There is a gradual progression of symptoms over several years or decades. In addition to pain, the following manifestations are determined:
- When moving, creaking, squeaking or clicking noises may occur.
- During an exacerbation, the periarticular area sometimes swells and turns red.
- Due to the instability of the joint, the patient often twists the leg, causing sprains and torn ligaments.
- Stiffness and limitation of movements are noted.
Complications
During an exacerbation, reactive synovitis may occur, accompanied by fluid accumulation in the joint. In later stages, a pronounced deformation is revealed. Movements are severely limited and contractures develop. Support becomes difficult; When moving, patients are forced to use crutches or a cane. There is a reduction or loss of work capacity.
Diagnostic
The diagnosis of ankle osteoarthritis is made by an orthopedic doctor on the basis of a survey, data from an external examination and the results of additional studies. When examined at first, there may be no changes, but later deformities, limitation of movements and pain on palpation are revealed. The first importance is given to visualization techniques:
- X-ray of the ankle joint. Plays a decisive role in establishing the diagnosis and determining the degree of osteoarthritis. The pathology is indicated by a narrowing of the joint space, proliferation of the edges of the joint surfaces (osteophytes). At a later stage, cystic formations and osteosclerosis of the subchondral zone (located under the cartilage) of the bone are detected.
- Tomographic studies. Used where indicated. In difficult cases, for a more accurate assessment of the condition of bone structures, the patient is additionally sent to a CT scan, and to examine soft tissues - to an MRI of the ankle joint.
Laboratory tests are unchanged. If necessary, to establish the cause of osteoarthritis and differential diagnosis with other diseases, consultations with relevant specialists are prescribed: neurologist, rheumatologist, endocrinologist.
Treatment of ankle osteoarthritis
The treatment of the pathology is long and complex. Patients are usually seen by an orthopedic surgeon on an outpatient basis. During the period of exacerbation, hospitalization in the trauma and orthopedics department is possible. The most important role in slowing the progression of osteoarthritis is played by lifestyle and the correct mode of physical activity. The patient therefore receives recommendations to lose weight and optimize the load on the leg.
Drug therapy
It is selected individually, taking into account the stage of osteoarthritis, the severity of symptoms and concomitant diseases. Includes general and local agents. The following groups of drugs are used:
- General NSAIDs. Tablets are generally used. Medications have a negative effect on the gastric mucosa, therefore for gastrointestinal diseases, "mild" drugs are preferable.
- Local NSAIDs. Recommended both during the period of exacerbation and during the remission phase. May be prescribed as an alternative if tablet-related side effects occur. Available in the form of ointments and gels.
- Chondroprotectors. Substances that help normalize metabolic processes in cartilage tissue. They are used in the form of creams, gels and preparations for intra-articular administration. Use medications containing glucosamine and collagen hydrolyzate.
- Hormonal agents. In case of severe pain that cannot be relieved by medication, intra-articular corticosteroids are administered no more than 4 times a year.
- Metabolic stimulants. To improve local blood circulation and activate tissue metabolism, nicotinic acid is prescribed.
Physiotherapeutic treatment
The patient is prescribed a physiotherapy complex, developed taking into account the manifestations and stage of the disease. The patient is referred to physiotherapy. In the treatment of osteoarthritis, massage and UHF are used. Additionally, in the treatment of pathology they use:
- laser therapy;
- thermal procedures;
- medicinal electrophoresis and ultraphonophoresis.
Surgery
Indicated in advanced stages of the disease when conservative treatment is ineffective, in cases of severe pain syndrome, deterioration in the quality of life of patients or limited work capacity. The operations are carried out in a hospital environment and are open and minimally invasive:
- Arthroscopic interventions. In case of significant cartilage destruction, arthroscopic chondroplasty is performed. Sanitation arthroscopy (removal of formations that hinder movement) is usually carried out in case of severe pain in stage 2 of osteoarthritis. The effect lasts for several years.
- Arthrodesis of the ankle joint. It is carried out in case of significant destruction of the joint surfaces, involves the removal of the joint and the "fusion" of the bones of the foot and lower leg. Helps restore the support function of the limb in the event of loss of joint mobility.
- Ankle joint endoprostheses. Performed for advanced osteoarthritis. Consists of removing the destroyed joint surfaces of the bones and replacing them with plastic, ceramic or metal prostheses. Movements are fully restored, the lifespan of the prosthesis is 20 to 25 years.
Forecast
The changes in the joint are irreversible, but the slow progression of osteoarthritis, rapid initiation of treatment and compliance with the recommendations of an orthopedic traumatologist make it possible in most cases to maintain work capacity and quality of life. high life for decades after onset. of the first symptoms. With a rapid increase in pathological changes, endoprostheses help to avoid disability.
Prevention
Preventive measures include reducing the level of injuries, especially in winter, during periods of ice. If you are obese, it is necessary to take measures to reduce body weight to reduce the load on the joint. You need to maintain a regime of moderate physical activity, avoid overloads and microtrauma, and promptly treat diseases that can trigger the development of osteoarthritis of the ankle joint.