Arthrosis of the ankle joint is a degenerative, dystrophic disease of the musculoskeletal system. Affects the lower limbs. It is considered one of the most common forms of arthrosis: it accounts for up to 30% of all cases of degenerative-dystrophic joint damage. The pathological process occurs not only in older patients. About a quarter of patients are under the age of 40.
This disorder is accompanied by constant pain and a gradual decline in joint and lower limb function. Without treatment it develops and does not go away on its own. Diagnosis and treatment of disorders is the work of orthopedic doctors (depending on the cause, traumatologists are involved, as well as physical therapists and physiotherapists).
Causes of ankle arthrosis
Osteoarthritis is considered a polyetiological disease. Its development occurs due to the influence of a group of causes. With age, the number of factors that provoke the disease increases, therefore the possibility of increasing the 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;
- injury;
- operations;
- metabolic diseases;
- uncomfortable shoes;
- other diseases of the musculoskeletal system;
- rheumatoid disease.
Irrational stress can be caused by lifestyle or as a result of the choice of profession. Continuous walking, standing in one place, carrying heavy objects, intense activity. All these are provocateurs of the pathological process in the medium term (several years).
Other causes are injuries, especially intra-articular fractures, dislocations, and even severe bruising (to some extent). Arthrosis of the ankle joint manifests itself unnoticed, but constantly develops. Often patients underestimate the consequences of the trauma they experienced.
Surgery can trigger arthrosis. However, such complications are relatively rare. Mainly due to incorrect assessment of clinical conditions. inadequate doctor qualifications.
Metabolic pathologies, such as diabetes mellitus, can trigger disorders. However, more often the cause of ankle arthrosis is gout, as well as hormonal disorders (for example, during menopause).
Uncomfortable shoes are one of the main factors in the development of the pathological process. This disorder develops due to improper load distribution on the feet. Usually complex disorders develop: not only arthrosis, but also spinal injuries. At least - osteochondrosis. But more dangerous problems are also possible.
Dysfunction of the musculoskeletal system itself also increases the likelihood of pathological processes. Intervertebral hernia, osteochondrosis, and congenital disorders create additional risks.
Rheumatoid diseases are represented by arthritis, systemic lupus erythematosus. Degenerative-dystrophic lesions are secondary, but they aggravate the underlying disease and worsen the prognosis.
Arthritis of the ankle joint is a multifactorial disease. As a rule, it develops under the influence of several reasons at once. There are exceptions, but they are rare. Also, a number of factors affect the severity of the disease and the rate of development of the pathological process.
The development of the pathological process is step by step. In the early stages, local blood circulation and dynamic load distribution on the legs are disrupted. Gradually, destructive processes in the cartilage are added. Moist inflammation begins. Deterioration of other ankle structures occurs: capsule, ligaments, bones, etc. The more advanced the disease, the more difficult the treatment. It requires more effort and time.
Factors that increase the risk of getting arthrosis
Dystrophic destruction of ankle joint tissue occurs not only due to the influence of immediate causes. The severity, likelihood of disease, and the nature of its course are influenced by risk factors. They complete the picture of the breach. Among them:
- the habit of wearing heels;
- the physically demanding nature of work (including professions with unclear risks: teachers, cooks also fall ill);
- previous injury to the ankle joint (there are cases where the disorder appeared several years after the injury);
- history of endocrine diseases (hormone disorders create additional risks);
- history of musculoskeletal disease;
- age 40+ (although this disease also occurs in younger people);
- weight gain;
- gender (women suffer more often than men).
Arthrosis of the ankle joint is a slowly developing disease; symptoms do not become apparent immediately. Therefore, it is difficult to assess the risk factors and causes that trigger 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:
- forms of post-traumatic disorders (developing after injury to the ankle joint or other structures of the musculoskeletal system);
- deforming arthrosis of the ankle joint: as a result of metabolic disorders or injuries, accompanied by slow but stable deformation of the joint;
- Metabolic arthrosis develops against the background of diabetes, hormonal disorders or gout (purine metabolism disorder).
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:
- early or early;
- progressive;
- advanced arthrosis.
In the first stage, there is no such clinical picture or it appears after intense physical activity. Pathological processes are detected only with the help of special diagnostic methods.
The progressive phase of the disorder is accompanied by clinical intensification. Symptoms appear after light physical activity. Reduced load tolerance. There is a constant pain syndrome, as well as limited movement of the leg in the ankle joint.
The last phase of the pathological process is accompanied by severe pain, as well as other symptoms in a state of complete rest. Both support and motor functions are affected. Often a person becomes disabled. Complex surgical treatment, including endoprosthetics, is required.
Important!
Staging plays the biggest role in determining treatment tactics and predicting the course and outcome of the disease. This disorder is best treated in the early stages. 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:
- sick;
- tiredness;
- exercise intolerance;
- swollen;
- disruption of leg support function;
- muscle weakness.
Pain in the legs is initially noticed only after intense physical activity. After that, even a little activity is enough. In advanced stages of the pathological process, pain is always present, regardless of the load.
Fatigue is observed from the first stage of the disorder. Feelings of muscle weakness and increased fatigue develop along with this disease. Signs indicate the further development of the disorder.
Exercise tolerance also gradually decreases. AT a clear level of disturbance, one cannot go up to the second or third floor. We need to stop.
Swelling is an ever-present sign. The leg at the ankle appears swollen and enlarged. This is a non-specific manifestation.
Starting pain is typical. After staying in one place for a long time, severe joint stiffness develops. The first movement causes a lot of discomfort. The 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 large role in determining the level and severity of the pathological process. Doctors systematize symptoms through a process of verbal questioning and history taking.
The disease is characterized by a chronic course. During the exacerbation period, the 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 disappear completely. 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 are related to maintaining work capacity and the ability to take care of oneself.
The patient has an ankle deformity. The pathological process ends with the formation of a contracture, an area of primary or complete immobility of the limb in the ankle. This condition can only be corrected through surgery.
At the time of exacerbation, the development of synovitis and inflammation of the synovial bursa is typical. This condition lasts several weeks and during the acute course completely removes the ability to work and move.
The end result of the pathological process is a decrease and then a complete loss of leg support function; the person cannot move normally. You have to use a stick. There is a complete loss of the ability to work, and in some cases, the ability to care for oneself. In advanced stages of ankle arthrosis, the patient becomes disabled.
Disease diagnosis
Diagnosis of damage to articular structures and cartilage tissue is carried out under the supervision of an orthopedic traumatologist. The exam is typical. It is not difficult to identify the pathological process, as well as its severity. Among the techniques:
- verbal interrogation of patients to better understand the nature of symptoms and health complaints;
- collecting anamnesis, which allows you to determine the possible origin of the pathological condition;
- palpation: arthrosis is indicated by deformation, swelling, pain during passive movement;
- 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 bone; CT allows detailed and accurate visualization of the nature of the disorder).
Notes!
Arthrosis does not have specific manifestations, especially in the early stages. Therefore, by itself, without sufficient knowledge, it is not 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 use a 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);
- chondroprotector;
- nicotinic acid and other ways to improve metabolic processes.
Exercise therapy and physiotherapy, along with massage, are aimed at recovery after the acute condition has been eliminated. This method is important during the remission period. If the disease occurs in an acute form with obvious clinical symptoms, the method is postponed.
Surgical treatment is required for defects and persistent deviations in joint anatomy. Joint plastic or endoprosthetic surgery, joint replacement with an artificial analogue is possible. This is a high-tech correction method.
Prediction
Prognosis depends on the time 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 recovery and full recovery are good. In other cases, surgery and a long recovery period are required.
Prevention of interference
Prevention of ankle arthrosis includes:
- wear comfortable shoes;
- timely treatment of musculoskeletal diseases;
- reasonable welfare control;
- weight control;
- avoid injury;
- load control.
Prevention can reduce the risk of ankle arthrosis by 2-3 times. The possibility of a pathological process will be minimal.