Arthrosis of the ankle joint is a degenerative, dystrophic disease of the structures of the musculoskeletal system. Affects the lower limb. It is considered one of the most common forms of arthrosis: it accounts for up to 30% of the total number of cases of 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 decrease in the function of the joint and lower limb. Without treatment it progresses and does not go away on its own. Diagnosis and treatment of the disorder is the work of an orthopedic doctor (depending on the cause, a traumatologist is involved, as well as physical therapy doctors and physiotherapists).
Causes of ankle arthrosis
Osteoarthritis is considered a polyetiological disease. Its development occurs as a result of the influence of a group of causes. With age, the number of disease provoking factors increases, hence the increased likelihood of a pathological process. But not everything is so simple.
Pathogenesis of the disorder
There are a group of causes of ankle arthrosis, among the most common:
- 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 a consequence of a choice of profession. Constant walking, standing in one place, carrying heavy objects, intense activity. All of these are provocateurs of the pathological process in the medium term (several years).
Another reason is injuries, especially intra-articular fractures, dislocations, and also severe bruises (to a lesser extent). Arthrosis of the ankle joint manifests itself unnoticed, but constantly progresses. Often patients underestimate the consequences of the trauma they have suffered.
Surgeries can provoke arthrosis. However, such a complication is relatively rare. Mainly due to an incorrect assessment of the clinical situation. insufficient qualification of the doctor.
Metabolic pathologies, such as diabetes mellitus, can provoke a disorder. However, much more often the causes of ankle arthrosis are gout, as well as hormonal disorders (for example, during menopause).
Uncomfortable shoes are one of the key factors in the development of the pathological process. The disorder develops due to improper distribution of the load on the foot. Usually complex disorders develop: not only arthrosis, but also spinal injuries. At a minimum - osteochondrosis. But more dangerous problems are also possible.
The dysfunctions of the musculoskeletal system themselves also increase the likelihood of a pathological process. Intervertebral hernias, osteochondrosis, and congenital disorders create additional risks.
Rheumatoid diseases are represented by arthritis, systemic lupus erythematosus. Lesions of a degenerative-dystrophic nature are secondary, but they aggravate the underlying disease and worsen the prognosis.
Arthrosis of the ankle joint is a multifactorial disease. As a rule, it develops under the influence of several causes at once. There are exceptions, but they are rare. Also, the number of factors affects the severity of the disease and the rate of progression of the pathological process.
The development of the pathological process is stepwise. At the initial stage, local blood circulation and the distribution of dynamic load on the foot are disrupted. Gradually, destructive processes in the cartilage are added. Sluggish inflammation begins. Degeneration of other structures of the ankle occurs: capsule, ligaments, bones, etc. The more advanced the disease, the more difficult the treatment. It requires more effort and time.
Factors of increased risk of developing arthrosis
Dystrophic destruction of the tissues of the ankle joint occurs not only as a result of the influence of immediate causes. The severity, likelihood of the disease, and the nature of its course are affected by risk factors. They complete the picture of the violation. Among them:
- habit of wearing heels;
- the physically difficult nature of the work (including professions with unobvious risks: teachers, cooks also get sick);
- previous injuries to the ankle joint (there are cases where the disorder manifested itself years after the injury);
- history of endocrine diseases (hormonal disorders create additional risks);
- history of musculoskeletal diseases;
- age 40+ (although the disease also occurs in younger people);
- increased body weight;
- gender (women suffer more often than men).
Arthrosis of the ankle joint is a disease that develops slowly; symptoms do not become apparent immediately. Therefore, it is difficult to assess what risk factors and causes provoke the pathological process. It is necessary to collect a complete medical history.
Classification and types of damage to the ankle joint
Pathology is classified according to two bases.
The first criterion is the origin of the pathological process. Highlight:
- post-traumatic form of the disorder (develops after injuries to the ankle joint or other structures of the musculoskeletal system);
- deforming arthrosis of the ankle joint: a consequence of metabolic disorders or injuries, accompanied by slow but steady deformation of the joint;
- Metabolic arthrosis develops against the background of diabetes, hormonal disorders or gout (purine metabolism disorders).
The second basis for classification is based on the staging of the pathological process. In its development, arthrosis of the ankle joint goes through the following stages:
- initial or early;
- progressive;
- advanced arthrosis.
At the first stage, there is no clinical picture as such or it appears after intense physical activity. The pathological process is detected only with the help of special diagnostic methods.
The progressive phase of the disorder is accompanied by an intensification of the clinic. Symptoms appear after mild physical activity. Load tolerance decreases. There is a constant pain syndrome, as well as limited mobility of the leg in the ankle joint.
The final phase of the pathological process is accompanied by severe pain, as well as other symptoms in a state of complete rest. Both supporting and motor functions are impaired. Often a person becomes disabled. Complex surgical treatment, including endoprosthetics, is required.
Important!
Staging plays the greatest 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 the correction.
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;
- disorders of the supporting function of the leg;
- muscle weakness.
Pain in the leg is initially observed only after intense physical activity. Then a little activity is enough. At the advanced stage of the pathological process, pain is always present, regardless of the load.
Fatigue is observed from the very first stage of the disorder. The feeling of muscle weakness and increased fatigue progresses along with the disease. Signs indicate further development of the disorder.
Exercise tolerance also gradually decreases. AT a pronounced stage of the disorder, a person cannot rise 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 puffy and enlarged. This is a nonspecific manifestation.
Starting pain is typical. After a long stay in one place, severe stiffness of the joint develops. The first movements cause a lot of discomfort. Pain and discomfort gradually fade away as the person continues to move.
The clinical picture depends on the degree of arthrosis of the ankle joint. Plays a big role in determining the stage and severity of the pathological process. The doctor systematizes symptoms through a process of oral questioning and history taking.
The disease is characterized by a chronic course. During periods of exacerbation, signs of arthrosis of the ankle joint appear most clearly. In the chronic phase, remission is only partial. The clinic is not so bright, but the symptoms do not completely go away. Then a new exacerbation of arthrosis of the ankle joint occurs, the manifestations again become intense. And so on in a circle until quality treatment is carried out.
Complications of ankle arthrosis
Complications of the pathological process relate to maintaining working capacity 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. The situation can only be corrected surgically.
At the time of exacerbation, the development of synovitis and inflammation of the synovial bursa is typical. This condition lasts several weeks and during its acute course completely eliminates 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 ability to work, and in some cases, the ability to self-care. At advanced stages of ankle arthrosis, patients become disabled.
Diagnosis of the disease
Diagnosis of damage to articular 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 its severity. Among the techniques:
- oral questioning of the patient to better understand the nature of symptoms and health complaints;
- collecting anamnesis, which allows you to determine the likely origin of the pathological condition;
- palpation: arthrosis is indicated by deformation, swelling, pain during passive movements;
- Ankle radiography: a routine examination that provides sufficient information to make a diagnosis and determine its severity, is considered the gold standard examination;
- MRI if radiographic data is insufficient.
Other studies may be conducted. For example, computed tomography (arthrosis affects not only cartilage, but also bones; CT allows detailed, accurate visualization of the nature of the disorders).
Note!
Arthrosis has no specific manifestations, especially at an early stage. Therefore, on your own, without sufficient knowledge, it will not be possible to distinguish pathological processes from each other. Special instrumental diagnostics are required.
Laboratory diagnostic techniques provide little data. They are only informative in terms of identifying the inflammatory process and help in diagnosing some forms of arthrosis (metabolic origin, rheumatoid nature).
Treatment methods
Treatment of arthrosis of the ankle joint is carried out using conservative and surgical techniques. The best results can be achieved if you resort to complex correction.
Conservative therapy includes the use of medications, exercise therapy and physiotherapy with massage. The following drugs are used:
- local anti-inflammatory;
- general anti-inflammatory drugs (in the form of tablets or injection solutions);
- chondroprotectors;
- nicotinic acid and other means to improve metabolic processes.
Exercise therapy and physiotherapy, together with massage, are aimed at recovery after the acute condition has been eliminated. These methods are significant during the period of remission. If the disease occurs in an acute form with pronounced clinical symptoms, the methods are postponed.
Surgical treatment is required for deformities and persistent deviations in the anatomy of the joint. Joint plastic surgery or endoprosthetics, joint replacement with an artificial analogue are possible. This is a high-tech correction method.
Forecasts
Prognosis depends on the moment of treatment, health status, cause of arthrosis, as well as the degree of development of the disorder. The more advanced the disease, the more complicated the situation. If treatment is started early, the prospects for cure and full recovery are good. In other cases, surgery and a long period of rehabilitation are required.
Prevention of the disorder
Prevention of ankle arthrosis includes:
- wearing comfortable shoes;
- timely treatment of musculoskeletal diseases;
- reasonable control of well-being;
- body weight control;
- avoiding injury;
- load control.
Prevention can reduce the risk of ankle arthrosis by 2-3 times. The likelihood of a pathological process will be minimal.