Osteoarthritis of the ankle joint is a degenerative and dystrophic disease of the structures of the musculoskeletal system. Affects the lower limb. It is considered one of the most common forms of osteoarthritis: it accounts for up to 30% of the total number of cases of degenerative-dystrophic joint damage. The pathological process occurs not only in elderly patients. About a quarter of patients are people under the age of 40.
The disorder is accompanied by persistent pain and a progressive 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 disease is the work of an orthopedic doctor (depending on the cause, a traumatologist is involved, as well as physiotherapist doctors and physiotherapists).
Causes of ankle osteoarthritis
Osteoarthritis is considered a polyetiological disease. Its development results from the influence of a group of causes. With age, the number of factors provoking the disease increases, hence the increased likelihood of a pathological process. But all is not so simple.
Pathogenesis of the disorder
There is a group of causes of ankle osteoarthritis, 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 the result of a lifestyle or a choice of profession. Constant walking, standing in one place, carrying heavy objects, strenuous activity. All of these elements are provocateurs of the pathological process in the medium term (several years).
Another reason are injuries, especially intra-articular fractures, dislocations and also serious bruises (to a lesser extent). Ankle osteoarthritis manifests itself unnoticed, but constantly progresses. Patients often underestimate the consequences of the trauma they have suffered.
Surgical procedures can cause osteoarthritis. However, such a complication is relatively rare. Mainly due to incorrect assessment of the clinical situation. insufficient qualification of the doctor.
Metabolic pathologies, such as diabetes mellitus, can cause a disorder. However, the causes of ankle osteoarthritis are much more often gout, as well as hormonal disorders (eg 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 osteoarthritis, but also spinal injuries. At a minimum - osteochondrosis. But more dangerous problems are also possible.
Malfunctions 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.
Ankle osteoarthritis is a multifactorial disease. As a rule, it develops under the influence of several causes at once. There are exceptions, but they are rare. In addition, 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 occurs in stages. At the initial stage, local blood circulation and dynamic load distribution on the foot are disrupted. Gradually, destructive processes in the cartilage are added. Slow inflammation begins. Degeneration 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.
Increased risk factors for developing osteoarthritis
Dystrophic destruction of the tissues of the ankle joint occurs not only under the influence of immediate causes. The severity, probability of the disease and the nature of its course are affected by risk factors. They complete the picture of violation. Among them:
- habit of wearing heels;
- the physically arduous nature of the work (including jobs with less obvious risks: teachers and cooks also fall ill);
- 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;
- 40 years and older (although the disease also occurs in younger people);
- increased body weight;
- gender (women suffer more often than men).
Ankle osteoarthritis is a disease that develops slowly and whose symptoms do not appear immediately. Therefore, it is difficult to assess which 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. Emphasize:
- post-traumatic form of the disorder (develops after injuries to the ankle joint or other structures of the musculoskeletal system);
- deforming osteoarthritis of the ankle joint: consequence of metabolic disorders or injuries, accompanied by slow but regular deformation of the joint;
- Metabolic osteoarthritis develops against the background of diabetes, hormonal disorders or gout (purine metabolism disorders).
The second basis of classification is based on the staging of the pathological process. In its development, ankle osteoarthritis goes through the following stages:
- initial or early;
- progressive;
- advanced osteoarthritis.
At the first stage, there is no clinical picture as such or it appears after intense physical activity. The pathological process is detected only using special diagnostic methods.
The progressive phase of the disorder is accompanied by an 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 leg at 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. Supportive and motor functions are impaired. Often a person becomes disabled. Complex surgical treatment, including stents, is necessary.
Important!
Staging plays the greatest role in determining treatment tactics and predicting the course and outcome of the disease. It is best to treat this disorder at an early stage. The more advanced the pathology, the more difficult and longer 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;
- muscular weakness.
Pain in the leg is initially observed only after intense physical activity. So 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 very first stage of the disorder. The feeling of muscle weakness and increased fatigue progresses with the disease. The signs indicate further development of the disorder.
Exercise tolerance also gradually decreases. At a pronounced stage of the disorder, a person cannot climb to the second or third floor. We have to make stops.
Swelling is an ever-present sign. The leg at the ankle appears swollen and enlarged. This is a non-specific manifestation.
The initial pain is typical. After a long stay in one place, severe stiffness in the joint develops. The first movements cause a lot of discomfort. The pain and discomfort gradually disappears as the person continues to move.
The clinical picture depends on the degree of osteoarthritis of the ankle joint. Plays an important role in determining the stage and severity of the pathological process. The doctor systematizes the symptoms through a process of oral questioning and history taking.
The disease is characterized by a chronic course. During periods of exacerbation, signs of osteoarthritis 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 disappear. Then a new exacerbation of ankle osteoarthritis occurs, the manifestations become intense again. And so on in a circle until quality processing is carried out.
Complications of ankle osteoarthritis
Complications of the pathological process concern the maintenance of work capacity and the ability to care for oneself.
Patients present with ankle deformities. The pathological process ends with the formation of contractures, areas of primary or complete immobility of the limb at the ankle level. 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 for 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 complete loss of the supporting function of the leg; the person cannot move normally. You must use crutches. 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 osteoarthritis, patients become 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 exams are typical. It is not difficult to identify the pathological process, as well as its degree of severity. Among the techniques:
- oral questioning of the patient to better understand the nature of symptoms and health problems;
- collect anamnesis, which allows you to determine the probable origin of the pathological condition;
- palpation: osteoarthritis is indicated by deformation, swelling, pain during passive movements;
- Ankle x-ray: a routine examination that provides sufficient information to make a diagnosis and determine its severity, is considered the gold standard;
- MRI if radiographic data is insufficient.
Other studies could be carried out. For example, CT scanning (osteoarthritis affects not only the cartilage, but also the bones; CT scanning allows detailed and precise visualization of the nature of the disorders).
Note!
Osteoarthritis does not have specific manifestations, especially at an early stage. Therefore, 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 the diagnosis of certain forms of osteoarthritis (metabolic origin, rheumatoid nature).
Treatment methods
Treatment of ankle osteoarthritis 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 injectable solutions);
- chondroprotectors;
- nicotinic acid and other means to improve metabolic processes.
Exercise therapy and physiotherapy, as well as massage, are aimed at recovery after the acute illness has been eliminated. These methods are significant during the remission period. If the disease occurs in an acute form with pronounced clinical symptoms, the methods are postponed.
Surgical treatment is necessary in cases of persistent deformities and deviations in the anatomy of the joint. Joint plastic surgery or endoprostheses, arthroplasty with an artificial analogue are possible. This is a high-tech correction method.
Forecasts
The prognosis depends on the time of treatment, the state of health, the cause of the osteoarthritis as well as the degree of progression of the disease. 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 necessary.
Prevention of the disorder
Prevention of ankle osteoarthritis includes:
- wear comfortable shoes;
- timely treatment of musculoskeletal diseases;
- reasonable welfare check;
- body weight control;
- avoid injury;
- Load control.
Prevention can reduce the risk of ankle osteoarthritis by 2 to 3 times. The likelihood of a pathological process will be minimal.