Osteoarthritis of the ankle joint is a degenerative-dystrophic lesion of the cartilaginous plate of the joint and the underlying bone.
Information about the disease, exacerbation and progression of the process
The disease begins primarily with damage to the cartilaginous base of the joint. Under the influence of unfavorable factors, the cartilage becomes thinner, fibers and cracks form, which contributes to the exposure of the underlying bone. During joint movements, the exposed bone experiences a non-physiological load, so it tries to "protect" itself. This causes compensatory osteosclerosis (hardening) in the underlying subchondral area, as well as the development of secondary subchondral cysts. In response, the ideal relationships of the articular surfaces are disrupted, which further aggravates the pathological process. As the disease progresses, the newly formed bone tissue forms growths (osteophytes) at the edges, which cause intense pain.
Deforming arthrosis of the ankle can be caused by various factors. These can be genetic, traumatic, growth and metabolic conditions. The initial destruction of the articular cartilage gradually leads to damage of all tissues of the synovial joints.
The main clinical signs of osteoarthritis are pain and limited mobility of the ankle. The disease is also characterized by the symptom of crepitus (crunching), the periodic appearance of effusion in the synovial cavity, as well as the secondary development of the inflammatory process. In addition to clinical examination, ultrasound of the joints and x-ray help establish the correct diagnosis. In complex cases, computed tomography or magnetic resonance imaging may be necessary.
Treatment of arthrosis of the ankle joint is usually carried out using conservative methods. To improve the functional state of the cartilaginous plate, chondroprotectors are prescribed, incl. with intra-articular administration route. Nonsteroidal (and, in particularly severe cases, steroidal) anti-inflammatory drugs help relieve pain. In case of severe destruction of the joint, replacement of the endoprosthesis is performed using third generation prostheses, completely integrated with the bone.
Types
What does arthrosis of the ankle joint mean, taking into account the mechanisms of development? According to the classification, there are 2 variants of the disease:
- primary arthrosis, also called idiopathic, when it is not possible to establish the true cause of the disease even with the most modern examination;
- secondary arthrosis, which is caused by the influence of one or more clearly defined causal factors listed above.
In clinical medicine, there are 6 degrees of ankle osteoarthritis:
- in the first degree, the superficial area of the cartilage is not damaged, but swelling and disintegration of the matrix occurs, the chondrocytes proliferate and the type of collagen they synthesize changes (normally the cartilaginous plate is formed by collagen of the second type, and in arthrosis is replaced by less durable collagen of the third type);
- in the second degree, the integrity of the superficial zone of the cartilaginous plate is disrupted, the position of chondrocytes in the deep zone changes;
- in the third degree, the progression of the pathological process leads to the appearance of vertical cracks;
- at the fourth degree the superficial area of the cartilage flakes, eroded surfaces appear and cysts appear;
- the fifth degree is characterized by the exposure of the underlying bone;
- at the sixth degree compensatory changes occur in the bone tissue, which consist of its compaction, formation of osteophytes and microfractures.
Symptoms
The main manifestation of ankle arthritis is pain. Distinctive features of pain syndrome in this disease are:
- the initial nature of the pain, when it is most pronounced at the beginning of the movement;
- of a mechanical nature, which leads to increased pain during physical activity and long walks;
- nocturnal pain caused by intraosseous stagnation of venous blood;
- block pain is a jam in the ankle, in which a person can neither bend nor straighten the leg, because the pain increases significantly (the block occurs due to fragments of dead cartilage getting stuck between the joint surfaces);
- weather dependence: pain intensifies when the weather changes, when it gets colder and the humidity of the air increases.
Ankle osteoarthritis is a chronic process. Painful periods, indicating an exacerbation of the disease, alternate with painless periods. As osteoarthritis progresses, the period between relapses shortens and at some point the pain may become permanent.
Causes of ankle arthritis
On average, in people from the age of 30, a gradual destruction of the cartilaginous plate occurs, which exceeds the speed of formation of new cartilage. Therefore, the prevalence of the disease increases with age. There are also some gender characteristics. Therefore, before menopause, women's joints are protected from destruction. With the onset of the menopausal transition, the protective effect of estrogen gradually decreases, therefore, starting from the age of 50, the incidence of the pathology in men and women equalizes.
The following causes of arthrosis of the ankle joint are identified, which lead to the fact that the process of resynthesis of cartilage tissue does not have time to cover the catabolism (destruction) of cartilage:
- has suffered traumatic injuries (jumping from a height represents a particular danger);
- previous inflammatory lesions of the joint;
- ankle deformities, which may be associated with flat feet, varus or valgus position of the foot;
- hereditary collagenopathies, in particular those that affect the synthesis of type 2 collagen;
- ankle dysplasia;
- excess body weight, which increases the load on the ankle and contributes to the "erasure" of the cartilaginous layers;
- postmenopausal period (the average age of persistent cessation of menstruation in women is 50-52 years);
- metabolic disorders;
- sedentary lifestyle;
- previous orthopedic operations on the joint;
- repeated hypothermia.
Diagnostics
If you suspect arthrosis of the ankle joint, the doctor recommends a further program of research. It can consist of the following methods:
- Ultrasound scanning - the study allows you to evaluate the condition of the soft tissue structures of the joint (cartilage, synovial bag and surrounding tissues), this is the most informative method for early diagnosis of arthrosis changes;
- X-rays: This method mainly evaluates the structure of bone tissue, helps to identify subchondral osteosclerosis, the presence of cysts in the subchondral area, and also to visualize osteophytes (using X-rays to detect initial changes in osteoarthritis, which affect mainly the cartilaginous plate, it is extremely difficult).
In difficult clinical cases, computed tomography or magnetic resonance imaging can be used to detail the condition of the ankle joint. Each of these methods allows you to obtain layer-by-layer scans (scan pitch 2-3 mm) of the studied area and evaluate the state of the intra- and extra-articular structures of the ankle.
Expert opinion
Studies have shown that hormones actively participate in the growth and differentiation processes of cartilage tissue. It has been established that chondrocytes have receptors for thyroid hormones, insulin, glucocorticosteroids, growth hormone, male and female sex steroids, as well as prolactin. Endocrine regulation disorders are considered an important causal factor that can disrupt the balance between the process of cartilage formation and destruction, thus leading to dystrophy and degeneration. Therefore, it is so important to monitor the state of endocrine-metabolic reactions in the body, conduct screening examinations to assess the functional state of the thyroid gland and contact an endocrinologist at the first suspicious symptoms.
Treatment of ankle arthritis
Treatment of arthrosis in the initial stages is carried out using conservative methods. Prompt therapy can protect the joint from destruction and delay or completely avoid the need for surgery. If the disease is detected in the stage of significant destruction of the cartilaginous plate and is accompanied by stiffness that interferes with human activity, endoprosthesis is indicated.
Conservative treatment
Conservative treatment of arthrosis begins with the creation of favorable conditions for the functioning of the joint. Advised:
- regular physiotherapy, swimming and water aerobics exercises are also useful;
- normalization of body weight (if it is excess);
- use of crutches or orthopedic sticks during exacerbation of the process;
- wear comfortable orthopedic shoes.
To improve the condition of the cartilaginous plate, chondroprotectors are used, which are injected mainly into the joint. Hyaluronic acid and PRP therapy (plasma therapy) restore the condition of the cartilage plate. To relieve pain, symptomatic treatment is carried out using non-steroidal anti-inflammatory drugs.
Surgery
Replacement of the ankle joint is a rather complex task, so surgeons of a modern medical center strictly adhere to modern surgical methodology, which allows them to achieve the best therapeutic results. Currently only third generation implants are used for this operation, which require the removal of only a small bone fragment. These prostheses stimulate osteoclasts (cells that form bone tissue), so they fuse well with the tibia, fibula and talus, ensuring special structural strength. A unique feature of the third generation prosthesis is that it allows movement not only of the main joint, but also of the joint between the fibula and the tibia, thus evenly distributing the load on the joint.
Ankle replacement surgery also involves correcting existing deformities and suturing damaged ligaments. This creates favorable conditions to maintain the stability of the joint and fully guarantee its functions.
Prevention of ankle arthritis
Prevention of arthrosis of the ankle joint consists in following the following recommendations:
- wear comfortable, non-compressive shoes, use orthopedic insoles;
- perform feasible physical exercises;
- use of special ankle braces when playing professional sports;
- exclusion of standing jump from above;
- timely correction of concomitant deformities of the lower limb.
Rehabilitation
After orthopedic surgery, temporary immobilization of the operated joint is performed. The period of immobility allows you to create optimal conditions for the restoration of bone tissue and helps the implant to integrate in the most complete way. After removal of the cast, healthy exercises under the supervision of a physiotherapist, massage and physiotherapy are indicated.
Questions and answers
Which doctor treats ankle arthritis?
Diagnosis and treatment of the disease is carried out by a traumatologist-orthopedist.
What is arthrodesis?
Arthrodesis is a surgical option previously used for ankle arthritis. The operation involves immobilization of the joint, which negatively affects gait, but allows for pain relief. Therefore, endoprosthesis replacement is considered a more optimal and physiological option for the surgical treatment of ankle arthritis.
Is it possible to play sports after ankle replacement?
After installing a third generation implant, a person can engage in "gentle" sports: skiing, swimming, cycling and light jogging. You should avoid high-impact sports: fast running, football, tennis, wrestling.