Arthropathy of the ankle joint

In recent years, experts around the world have noted an increase in degenerative-dystrophic processes in the ankle, which gradually leads to disability. Ankle joint disease often develops as a result of serious injuries or permanent minor injuries to athletes, professional dancers, circus performers. You will learn in this article how to notice the signs of this disease in time and stop its development, as well as how it is treated.

Ankle arthritis - what it is

The ankle is a complex joint that looks like a block formed by the lower (distal) ends of the tibia and fibula of the lower leg, forming the inner and outer ankles (ankles), as well as the ankle of the foot. From the inside, it is reinforced by the deltoid ligament, from the outside - by the anterior and posterior astrologers and finned ligaments. Function: leg flexion and extension. The ankle is functionally connected to the foot, it has joint ligaments and muscular tendons with the joints of the foot.

Ankle joint disease is a degenerative-dystrophic disease that begins with thinning and destruction of articular cartilage, reducing its degrading properties, followed by the integration of all other joint tissues in the pathological process. The disease gradually leads to complete joint wear and disability. The ICD-10 ankle joint disease code is M19.

The disease is less common than a similar knee injury and is usually the result of serious injury or long-term injury as a result of any activity.

Causes of osteoarthritis of the ankle

Experts have studied in detail the reasons for the development of ankle joint disease and foot arthritis. This:

• injuries - intra-articular fractures of the joints, fractures of the ankles, complete and incomplete ruptures of ligaments and tendons.
• minor injury due to any professional activity - these are ballerinas, dancers, professional athletes.
• increased load on the legs with excessive body weight.
• improper load distribution when wearing high-heeled shoes.
• metabolic disorders that have a negative effect on cartilage tissue metabolism - diabetes mellitus, obesity, gout, etc.
• hormonal, including age-related changes.
• transferred severe acute purulent arthritis.
• long-term chronic arthritis of any origin.
• osteochondrosis of the lumbar spine and intervertebral hernia, which causes involvement of the roots of the spine and weakening of the muscles of the tibia and leg, leading to instability and injuries of the joints.

Mechanism of disease development (pathogenesis)

Under the influence of various reasons, the blood circulation in the joint area is disturbed, which leads to a reduction in the volume of synovial fluid that supplies the cartilage tissue. Due to the lack of oxygen and nutrients, the cartilage becomes thinner, cracks and erosions appear on it. This leads to injury to the subchondral layer of the bone. Thickens (hardens) and grows along the edges of the articular surfaces. These growths are called osteophytes. They compress the soft tissues, blood vessels and nerves, causing pain and further disrupting blood circulation.

Due to circulatory disorders and high intensity, the muscles suffer, weaken, which leads to joint instability and frequent dislocations. Arthropathy of the foot develops, small joints of the tarsus, metatarsal-tarsal, metatarsophalangeal and mesophalangeal joints are affected.

Gradually, connective tissue develops in the joints, binding tightly to the joint surfaces and disrupting joint function. Complete loss of ankle function is associated with fusion of the bony joints. The arthropathy of the foot gradually develops.

Symptoms of osteoarthritis of the ankle

Ankle arthritis progresses slowly and imperceptibly at first. But the symptoms appear gradually and increase, signaling some kind of violation in the lower extremity.

First signs

The first symptom of ankle arthritis is pain during high loads, for example, during long walks, dancing, football or volleyball etc. This pain passes quickly, so the person does not immediately pay attention to it, attributing it to muscle fatigue. The pain can be both symmetrical in both joints (with high loads and minor injuries) and unilateral (after a serious injury).

Then there is a feeling of stiffness in the morning or after a long stay still. The ankles become stiff for a while, making it difficult to move. In the initial stages it lasts a few minutes and passes after a slow pacing. This symptom should already warn and be discussed to go to the doctor.

Obvious symptoms

Gradually, the pain after exercise intensifies and lasts longer. The foot can hurt all day. Nocturnal aches and pains usually occur in the second half of the night and are sometimes accompanied by painful muscle cramps. Periods of rigidity after immobility are also extended.

Due to severe pain, a person begins to limp while walking, trying to reduce the pain in the leg by stretching or pushing it. Sometimes the ankle is swollen, the skin on it is red, the pain intensifies. This is a sign of arthritis - inflammation of the inner joint membrane. Inflammation is non-infectious in nature, develops from mechanical irritation and resolves on its own without treatment. But at the same time, the outbreak of arthritis activates the development of the joint degenerative-dystrophic process.

Dangerous symptoms

Persistent pain aggravated by physical exertion, instability, joint loosening, tendency to dislocate, dislocate and ligament injuries are dangerous symptoms that require a visit to a doctor. The ankle changes externally: it takes on a different shape due to the overgrown osteophytes. Ankle joint disease (ankle) leads to thickening. The movements of the foot are initially slightly restricted, and then the ankle becomes motionless or vice versa, relaxed, unstable. But even at this stage, the patient can be helped, you just need to contact the clinic. Symptoms of ankle sprains appear: pain in the leg, violation of the bend and its devaluation. The development of the big toe joints is accompanied by pain and deformity of the foot in the form of swelling and bending of the big toe outwards.

What is dangerous ankle arthropathy

The risk is that the disease initially progresses imperceptibly and very often the patient goes to the doctor, already having an advanced stage.

Any localization and form of arthritis has serious complications, so you should not delay treatment.

Classification

Ankle arthropathy can be primary, when the cause of its development has not been documented, and secondary, with a known cause. Depending on the cause of the disease, the disease may have its own distinctive features.

Post-traumatic arthropathy of the ankle joint

The consequences of a traumatic injury are the most common cause of the disease. Post-traumatic arthropathy of the ankle joint can develop after a serious injury - ligament rupture, dislocation, intra-articular fracture. Usually one joint is injured, so post-traumatic arthropathy is unilateral. A small but untreated injury may not be felt at first. And only after a while, when a person has already forgotten it, a slight increasing pain appears. This type of injury is dangerous because the patient goes to the doctor already in a neglected condition. Serious injuries are better treated, their consequences appear faster and the patient seeks medical help not so late.

The indistinguishable long-term micro-injury of both ankles is typical for professional dancers, athletes and people whose profession is associated with a long stay on their feet. There is symmetrical pain in the ankles during exercise. They are usually confused with muscle pain with fatigue, so it is also too late to see a doctor.

Ankle arthritis after arthritis

The causes of these joints can be chronic inflammatory processes in the joints (arthritis): rheumatoid, reactive, psoriatic. In this case, the inflammatory processes are combined with degenerative-dystrophic (arthritis-arthritis). This speeds up the process of destroying the ankle. With the exacerbation of inflammation, the joints swell, the skin on them becomes red, the pain becomes very intense, especially at night. When the inflammation subsides, metabolic disorders predominate, and all processes develop very rapidly. The disease requires constant monitoring and treatment by a rheumatologist.

Much less often, the degenerative-dystrophic process develops after acute purulent arthritis. The purulent process destroys the articular tissues and, after restoration, connective tissue is formed in their place, which disrupts the function of the limb.

Arthropathy can also form after infectious arthritis - tuberculosis, gonorrhea, etc. The course of the disease is related to the main infectious process and the nature of the catastrophe. If the infection persists, joint destruction will proceed.

Metabolic

It develops with a long course of gout. The first toe is very often affected. Other small joints of the foot and ankle are affected less often. As gout attacks continue, it is difficult to determine externally when the degenerative-dystrophic process occurs. You can only see it on an x-ray. In any case, the patient should be regularly monitored by a rheumatologist and examined periodically.

Deformative arthropathy of the ankle joint

All types of joints become deformed over time. Bone deformities indicate an advanced stage of the disease, when the cartilage has already collapsed and the constant mechanical impact on the bone tissue contributes to its development along the edges of the joint surface. This is how osteophytes are formed that change the joint shape.

Degrees of ankle joints

There are several classifications, one of which distinguishes three clinical and radiological stages of arthropathy:

1. Early. Slight pain after prolonged standing or walking, some stiffness in the morning. All this disappears quickly without any help. X-ray: normal or slight narrowing of the joint space.
2. progressive. The pain after exercise is stronger and greater. Stiffness increases, creases appear in the joints during movement. Sometimes the joint swells, reddens and hurts a lot - a sign of arthritis. X-ray shows significant narrowing of the joint space, thickening of the subchondral bone tissue (osteosclerosis) and proliferation of osteophytes.
3. Final. The pain syndrome intensifies, becomes permanent. Because of the pain, a person limps, presses his legs, uses a cane or crutches. The function of the limb is impaired, arthropathy of the foot and thumb develops. The complete absence of flexion-extension movements is rare, usually with a background of arthritis-arthritis. On X-ray: there is no joint space, osteosclerosis, large osteophytes that deform the joint.

Possible Complications

If the disease is not treated and we let everything go its own way, then the following complications are possible:

• persistent joint dysfunction and disability.
• severe incessant pain in the ankle and legs, both after and without exercise.
• ankle instability with the development of common dislocations and subluxations.
• Injury to the foot and thumb will join, which will further aggravate the patient's condition.

Diagnosis of ankle joint

Before prescribing treatment, the doctor examines the patient, including:

• medical interview and examination;
• Additional research methods: laboratory tests (signs of inflammation and metabolic disorders are detected), organic studies (x-ray of the joint in two projections, computed tomography and magnetic resonance imaging - early changes in bone structures and soft tissues are detected), diagnostic arthroscopy (examinationjoint surface).

Treatment of ankle joint disease

After establishing the final diagnosis, the doctor selects an individual therapeutic complex for the patient, consisting of pharmaceutical and non-pharmaceutical methods.

Medical treatment of osteoarthritis of the ankle joint

Drugs that are symptomatic (eliminate the symptoms of the disease) and pathogenetic (suppress the mechanism of disease development) are prescribed.

Anti-inflammatory and painkillers

To eliminate the pain, drugs from the group of non-steroidal anti-inflammatory drugs (NSAIDs) are prescribed in short doses, well relieve pain and inflammation (if arthritis has worsened):

• injection;
• anal suppositories;
• oral tablets;
• skin patch.

Muscle relaxants

The muscles that surround the affected joint and make it move are in constant tension, which leads to their atrophy and increases pain. To eliminate muscle spasms, drugs from the group of muscle relaxants are prescribed.

Chondroprotective

Drugs from the chondroprotective group contain glucosamine or chondroitin, and sometimes both. They protect cartilage cells from destruction and promote their repair. They are prescribed in the form of injections, tablets and external agents (creams and ointments).

Hyaluronic acid preparations for ankle joints

To improve the shock-absorbing capacity of synovial fluid and to prevent further injury to cartilage and bone tissue, hyaluronic acid is injected into the joint cavity. This results in pain relief and improved joint mobility.

Anti-arthritic gels and ointments for ankle joints

External media can be used at home. Ointments for ankle joints:

• NSAID gels are suitable for relieving pain and inflammation.
• for the restoration of cartilage - gel and ointment based on chondroitin.

Non-drug treatment

The main methods of treating ankle arthropathy are non-pharmaceutical. These are therapeutic exercises, massage, physiotherapy, use of orthopedic devices.

Physiotherapy

To alleviate the patient's condition and restore joint function, set:

• electrophoresis with drugs.
• laser treatment;
• magnetotherapy?
• heating processes - paraffin, ozokerite, in resort conditions - mud applications.

Massage for osteoarthritis of the ankle joint

Massage classes improve blood circulation, which leads to the activation of metabolism, the restoration of joint and extraarticular tissues. The positive effect of massage on the muscles is the elimination of the spasm, which helps the blood flow to the muscles and the restoration of their strength, necessary to keep the limb in the desired position.

Exercises and exercise therapy for ankle joint disease

Therapeutic gymnastics is a panacea for arthritis. Motor activity is very important, in addition to exercise, swimming is useful. The systematic application of the exercises chosen by the doctor allows you to greatly restore the function of the limb, even with advanced disease.

An approximate set of exercises (but before you start applying it, you should consult your doctor):

Use of special orthopedic products

In order to prevent the progression of the disease, the doctor may prescribe the use of a special orthopedic device - orthosis. It secures the foot in the correct anatomical position, relieves muscle tension, improves blood circulation. The use of a spelling is prescribed by a doctor, who also selects the most appropriate model.

The ankle can also be fastened using tape: with special adhesive tapes, the ankle is gently fastened in the desired position.

Surgery

Surgery is recommended for severe pain that is not eliminated by conservative methods of treatment, as well as for significant limb dysfunction.

Types of surgeries

The operations can be performed in traditional and gentle ways:

1. Therapeutic arthroscopy (jaw surgeries):
   • Arthritis of the joint cavity - with the help of an arthroscope, fragments of cartilage and bone tissue are removed from the cavity, which interfere with movement and cause pain.
   • Chondroplasty - removes the damaged cartilage layer, which stimulates the growth of new cartilage cells (inactive chondroplasty). In some cases, transplants of autochondral sections taken from uncharged areas of the patient's knee joint are performed (mosaic arthroplasty). Chondroplasty is effective in the 2nd stage of the disease, when the joint has not yet lost its function.
2. Arthritis is a traditional surgery. It is performed with a significant violation of limb function, its relaxation, the usual dislocations and pain. The joint is removed, the bones of the lower leg are fused with the bones of the foot. The ankle becomes immobile and serves only as a support.
3. Endoprosthesis is the replacement of a worn and lost ankle function with an artificial one.

Rehabilitation features after surgery

All operations are performed in stable conditions, after which the specialists recommend complete recovery. With sparing surgeries, rehabilitation is performed in outpatient clinics with timely integration into the course of therapeutic exercises with the exception of high loads on the joint. After the endoprosthesis, the patient remains in the hospital for a week and then rehabilitation measures are performed in outpatient clinics. After two weeks, the sutures are removed and the patient can take a shower.

Diet

There is no specific diet for osteoarthritis. But to eliminate unnecessary pressure on the ankle, it is necessary to maintain a normal body weight. A person should get a proper healthy diet, but the volume of high calorie foods should be partially replaced by vegetables and fruits. The first and second dishes with low fat, chicken, sea fish, cottage cheese, cheese, dairy products are useful.

Traditional medicine

Using traditional medicine only for arthritis will not help. But they can be used as part of a combination therapy prescribed by a doctor. Here are some recipes:

• for oral administration: wild rosemary infusion. Pour 20 g of chopped grass overnight in a thermos with 500 ml of boiling water, drain in the morning and take half a glass 4 times a day for a month. analgesic, cartilage tissue repair.
• for oral administration: take a ball of mummy with a diameter of 0. 5 cm in the morning, chewing well, 30 minutes before meals for 10 days. break 5 days and then repeat everything 3 more times. excellent stimulator of metabolic processes.
• Honey massage: apply warm liquid honey to the ankle before going to bed and rub lightly, massaging the tissues, for 5 minutes. then wrap the leg in a warm shawl and leave it until morning. restores blood circulation and metabolism in cartilage tissue.

Approach to treatment in clinics

Clinicians have developed their own approach to treating diseases such as ankle and foot arthritis. At the initial appointment, a thorough examination of the patient is performed, the doctor carefully listens to his complaints and the history of the disease, after which he prescribes additional laboratory and organic studies, including magnetic resonance imaging. Only after that the doctor determines the final diagnosis, prescribes and agrees with the patient for complex treatment. Consists of:

• modern regimens of medical and non-pharmacological treatment of arthropathy - drugs, physiotherapy, exercise therapy and massage, methods of ankle fixation.
• Traditional methods of oriental therapy - acupuncture, moxibustion, acupressure, various methods of kinesiotherapy, including tape.

These are not all methods used in clinics. Doctors are able to combine western and eastern methods, significantly accelerating the improvement of the patient's condition. Patients get rid of pain quickly, their quality of life improves significantly.

It combines tried and tested techniques of the East and innovative methods of Western medicine.

Prevention of foot arthritis

To reduce the risk of developing the disease, the following recommendations should be followed:

• Activity, exercise therapy, swimming should become part of your life.
• High physical activity and any traumatic factors should be excluded; hiking should be combined with rest, if your feet are injured during work, then it is worth changing.
• Injuries, especially in winter on the ice, should be ruled out by considering the modes of movement and the shoes used.
• Rational nutrition is essential for restoring metabolism, but being overweight is an extra burden on the ankle, get rid of it.
• Preventive therapy courses are a guarantee of a pain-free life.

Frequently asked questions about the disease

1. Which doctor should I go to for osteoarthritis of the ankle and arthropathy of the foot?

   To the orthopedic-traumatologist. But if the disease developed as part of some kind of rheumatic process, then to a rheumatologist.

2. What predictions do doctors usually make?

   It is possible to stop the degenerative process and improve the quality of life at any stage, but it is best to do this at the beginning of the disease, do not expect complications.

3. Can Osteoarthritis Of The Ankle Develop In Children?

   Maybe after an injury or with a background of a congenital pathology.

4. What are the consequences of the disease?

   Untreated arthropathy leads to disability. If you start treatment on time, it is very likely that limb function will be maintained. Treatment in the later stages will relieve pain and improve quality of life.

5. Are Sports Injuries The Cause Of Osteoarthritis In The Ankle?

   Yes, sports injuries are one of the leading causes of this disease.

6. Is it possible to tap on the ankle with arthropathy?

   It is possible, but it must be done by a specialist.

Ankle joint disease is almost always the result of macro- or micro-injuries. It proceeds slowly and imperceptibly at first. Therefore, timely treatment and recovery after injuries is as important as communication with a doctor at the first signs of ankle disease.