Arthrosis of the ankle joint is a degenerative, dystrophic disease of the structures of the musculoskeletal system. It affects the lower extremities. It is considered one of the most common forms of arthrosis: it accounts for up to 30% of the total number of degenerative-dystrophic joint damage cases. The pathological process does not occur only in elderly patients. About a quarter of patients are under the age of 40.
The disorder is accompanied by persistent pain and a gradual decline in joint and lower limb function. It progresses without treatment and does not go away on its own. Diagnosis and treatment of the disease is the work of an orthopedic doctor (depending on the cause, a traumatologist, as well as physiotherapy doctors and physiotherapists are involved).
Causes of ankle arthrosis
Osteoarthritis is considered a polyetiological disease. Its development occurs as a result of the influence of a group of reasons. With age, the number of factors that cause the disease increases, so the probability of the pathological process increases. But everything is not so simple.
Pathogenesis of the disease
Among the most common, there are a group of causes of ankle arthrosis:
- 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 choice of profession. Constant walking, standing still, carrying heavy objects, intense activity. All these are medium-term (several years) provocateurs of the pathological process.
Other causes are injuries, especially intra-articular fractures, dislocations, as well as severe bruises (to a lesser extent). Arthrosis of the ankle joint manifests itself imperceptibly, but it is constantly progressing. Patients often underestimate the consequences of their trauma.
Operations can cause arthrosis. However, such a complication is relatively rare. It is mainly due to the incorrect assessment of the clinical situation. insufficient qualification of the doctor.
Metabolic pathologies, for example, diabetes mellitus, can cause the disorder. However, more often the causes of ankle arthrosis are 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. The disorder develops due to improper distribution of the load on the foot. Complex disorders usually develop: not only arthrosis, but also spinal injuries. At least - osteochondrosis. But more dangerous problems are also possible.
Dysfunctions of the musculoskeletal system also increase the probability of the occurrence of the pathological process. Intervertebral hernias, osteochondrosis, and congenital disorders pose additional risks.
Rheumatoid diseases are represented by arthritis, systemic lupus erythematosus. Degenerative-dystrophic lesions are secondary, but they aggravate the main disease and worsen the prognosis.
Ankle arthrosis 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, the number of factors affects the severity of the disease and the speed of development of the pathological process.
The development of the pathological process is gradual. At the initial stage, local blood circulation and distribution of dynamic load on the leg are disturbed. Destructive processes are gradually added to the cartilage. Slow 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 that increase the risk of developing arthrosis
Dystrophic destruction of the tissues of the ankle joint does not occur only as a result of sudden causes. The severity, probability and nature of the course of the disease are affected by risk factors. They complete the picture of the violation. Among them:
- the habit of wearing heels;
- that the work is physically difficult (including professions with non-obvious risks: teachers, cooks also get sick);
- previous injuries of the ankle joint (there are cases where it manifests itself years after the injury);
- history of endocrine diseases (hormonal disorders pose additional risks);
- history of musculoskeletal diseases;
- age 40+ (the disease also occurs in young people);
- increased body weight;
- gender (women suffer more than men).
Ankle arthrosis is a slowly developing disease, symptoms do not appear immediately. Therefore, it is difficult to assess which risk factors and causes provoke the pathological process. A complete history should be collected.
Classification and types of ankle joint injuries
Pathology is classified on two grounds.
The first criterion is the origin of the pathological process. Emphasize:
- post-traumatic form of the disorder (develops after damage to the ankle joint or other structures of the musculoskeletal system);
- deforming arthrosis of the ankle joint: the result of metabolic disorders or injuries accompanied by slow but continuous 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 stage of the pathological process. In its development, arthrosis of the ankle joint goes through the following stages:
- primary or early;
- progressive;
- advanced arthrosis.
In the first stage, there is no clinical picture or it appears after intense physical activity. The pathological process is detected only with the help of special diagnostic methods.
The progressive stage of the disorder is accompanied by the intensification of the clinic. Symptoms appear after light physical activity. Load tolerance decreases. There is a constant pain syndrome, as well as limited mobility of the foot in the ankle joint.
The final stage of the pathological process is accompanied by severe pain, as well as other symptoms at complete rest. Both supporting and motor functions are impaired. Often a person is disabled. Complex surgical treatment, including endoprosthetics, is required.
It is important!
The stage plays the biggest role in determining the treatment tactics and predicting the course and outcome of the disease. The disease 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;
- tiredness;
- intolerance to sports;
- swelling;
- violation of the supporting function of the leg;
- muscle weakness.
Pain in the leg is observed at first only after intense 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 disorder. Muscle weakness and increased fatigue progress with the disease. Signs indicate that the disorder is progressing further.
Exercise tolerance also gradually decreases. In an open stage of the disorder, a person cannot climb to the second or third floor. We have to make stops.
Bloating is an ever-present symptom. The foot at the ankle appears swollen and enlarged. This is a non-specific manifestation.
Onset pain is typical. After staying in one place for a long time, severe stiffness of the joint develops. The first moves cause a lot of anxiety. As the person continues to move, the pain and discomfort gradually disappear.
The clinical picture depends on the degree of ankle arthrosis. It plays a major role in determining the stage and severity of the pathological process. The doctor systematizes the symptoms through the process of verbal questioning and history taking.
The disease is characterized by a chronic course. The symptoms of arthrosis of the ankle joint are most obvious in the periods of exacerbation. In the chronic phase, remission is only partial. The clinic is not so bright, but the symptoms do not go away completely. Then a new exacerbation of arthrosis of the ankle joint occurs, the manifestations intensify again. In a circle, etc. , until quality treatment is carried out.
Complications of ankle arthrosis
Complications of the pathological process are related to maintaining the ability to work and self-care.
Deformation of the ankle is observed in patients. The pathological process ends with the formation of contractures, areas of the main or complete immobility of the limb in the ankle. The condition can only be corrected surgically.
During exacerbation, the development of synovitis and inflammation of the synovial bursa are characteristic. This condition lasts for several weeks and in its acute course completely eliminates the ability to work and move.
The final result of the pathological process is a decrease in the supporting function of the leg and then its complete loss, the person cannot move normally. You must use supports. He loses the ability to work, and in some cases, the ability to take care of himself completely. In 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. Exams are typical. It is not difficult to determine the pathological process, as well as its degree of severity. Techniques include:
- verbal questioning of the patient to better understand the nature of symptoms and health complaints;
- collect anamnesis, which allows determining the probable origin of the pathological condition;
- palpation: arthrosis is indicated by deformation, swelling, pain during passive movements;
- X-ray of the ankle: a routine examination that provides sufficient information to diagnose and determine its severity is considered the gold standard examination;
- If radiographic data are insufficient, MRI.
Other studies may be conducted. For example, computer tomography (arthrosis affects not only cartilage, but also bones; CT allows detailed, accurate visualization of the nature of disorders).
Note!
Arthrosis has no special manifestations, especially in the early stages. Therefore, on your own, without sufficient knowledge, it will not be possible to distinguish pathological processes from each other. Special instrumental diagnostics is required.
Laboratory diagnostic methods give little information. They are informative only in terms of identifying the inflammatory process and help to diagnose some forms of arthrosis (metabolic origin, rheumatoid nature).
Treatment methods
Treatment of arthrosis of the ankle joint is carried out using conservative and surgical methods. The best results can be achieved if you resort to comprehensive correction.
Conservative therapy includes the use of drugs, 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, along with massage, are aimed at recovery after the acute condition has been resolved. These methods are important during remission. If the disease occurs with acute clinical symptoms, the methods are postponed.
Deformations and persistent deviations in the anatomy of the joint require surgical treatment. It is possible to replace joints with joint plastic surgery or endoprosthetic, an artificial analogue. This is a high-tech correction method.
Predictions
The prognosis depends on the time of treatment, health status, causes 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 long-term rehabilitation are required.
Prevention of disorder
Prevention of ankle arthrosis includes:
- wear comfortable shoes;
- timely treatment of diseases of the musculoskeletal system;
- reasonable control of welfare;
- body weight control;
- avoid injury;
- load control.
Prevention can reduce the risk of ankle arthrosis by 2-3 times. The probability of the occurrence of a pathological process will be minimal.