Arthrosis of the ankle joint

Osteoarthritis of the ankle joint is a chronic disease affecting articular cartilage, and subsequently other structures of the joint (capsule, synovial membrane, bones, ligaments). It has a degenerative-dystrophic character. It is manifested by pain and restriction of movements, subsequently progressive violations of the functions of support and walking are noted. The diagnosis is made on the basis of symptoms, examination data and radiography. Treatment is usually conservative, anti-inflammatory drugs, chondroprotectors and glucocorticoids are used, physical therapy and physiotherapy are prescribed. In severe cases, rehabilitation arthrocopy, arthrodesis or endoprosthetics are performed.

General information
Osteoarthritis of the ankle joint is a disease in which the articular cartilage and surrounding tissues are gradually destroyed. The disease is based on degenerative-dystrophic processes, inflammation in the joint is secondary. Arthrosis has a chronic undulating course with alternating remissions and exacerbations, gradually progressing. Women and men suffer equally often. The probability of development increases dramatically with age. At the same time, experts note that the disease is “getting younger” – every third case of arthrosis of the ankle joint is currently detected in people younger than 45 years.

Reasons
Primary arthrosis occurs for no apparent reason. Secondary damage to the ankle joint develops under the influence of some unfavorable factors. In both cases, the basis is a violation of metabolic processes in the cartilage tissue. The main causes and predisposing factors of the formation of secondary arthrosis of the ankle joint are:

major intra- and periarticular injuries (fractures of the talus bone, fractures of the ankles, tears and ruptures of ligaments);
operations on the ankle joint;
excessive load: too intense sports, prolonged walking or constant standing due to working conditions;
wearing high-heeled shoes, overweight, permanent microtrauma;
diseases and conditions associated with metabolic disorders (diabetes mellitus, gout, pseudopodagra, lack of estrogens in postmenopause);
rheumatic diseases (SLE, rheumatoid arthritis);
osteochondrosis of the lumbar spine, intervertebral hernias and other conditions that are accompanied by nerve infringement and disruption of the muscular apparatus of the foot and lower leg.
Less often, the cause of arthrosis is nonspecific purulent arthritis, arthritis with specific infections (tuberculosis, syphilis) and congenital malformations. Unfavorable environmental conditions and hereditary predisposition play a certain role in the development of arthrosis.

Pathogenesis
Normally, the articular surfaces are smooth, elastic, slide freely relative to each other during movements and provide effective cushioning under load. As a result of mechanical damage (injury) or metabolic disorders, the cartilage loses its smoothness, becomes rough and inelastic. Cartilages “rub” during movements and injure each other, which leads to an aggravation of pathological changes.

Due to insufficient depreciation, excessive load is transferred to the underlying bone structure, degenerative and dystrophic disorders also develop in it: the bone is deformed and grows along the edges of the articular area. Due to secondary traumatization and disruption of the normal biomechanics of the joint, not only the cartilage and bone, but also the surrounding tissues suffer.

The capsule of the joint and the synovial membrane thicken, foci of fibrous degeneration form in the ligaments and periarticular muscles. The ability of the joint to participate in movements and withstand loads decreases. Instability occurs, pain syndrome progresses. In severe cases, the articular surfaces are destroyed, the supporting function of the limb is disrupted, movements become impossible.

Symptoms
At first, rapid fatigue and indistinct pain in the ankle joint are detected after a significant load. Subsequently, the pain syndrome becomes more intense, its nature and time of occurrence change. Distinctive features of pain in arthrosis are:

Starting pains. They appear after a state of rest, and then gradually disappear during movements.
Load dependence. There is an increase in pain during exercise (standing, walking) and rapid fatigue of the joint.
Night pains. Usually appear in the morning.
The condition changes in waves, during exacerbations the symptoms are more pronounced, in the remission phase they first disappear, then become less intense. There is a gradual progression of symptoms over several years or decades. Along with the pain , the following manifestations are determined:

Crunching, creaking or clicking may occur during movements.
During the period of exacerbation, the periarticular area sometimes swells and turns red.
Due to the instability of the joint, the patient often twists the leg, sprains and ligament tears occur.
Stiffness and restriction of movements are noted.
Complications
During the period of exacerbation, reactive synovitis may occur, accompanied by the accumulation of fluid in the joint. In the later stages, pronounced deformation is revealed. Movements are sharply limited, contractures develop. Support is difficult, when moving patients are forced to use crutches or a cane. There is a decrease or loss of working capacity.

Diagnostics
The diagnosis of arthrosis of the ankle joint is made by an orthopedic surgeon based on a survey, external examination data and the results of additional studies. When examined at the initial stages, there may be no changes, deformities, restriction of movements, pain during palpation are subsequently detected. The leading importance is given to visualization techniques:

Radiography of the ankle joint. Plays a crucial role in the diagnosis and determination of the degree of arthrosis. The pathology is indicated by the narrowing of the articular gap, the proliferation of the edges of the articular surfaces (osteophytes). At a late stage, cyst-like formations and osteosclerosis of the subchondral (located under the cartilage) bone zone are detected.
Tomographic studies. They are used in the presence of indications. In difficult cases, for a more accurate assessment of the condition of the patient’s bone structures, they are additionally sent for computed tomography, for soft tissue examination – for an MRI of the ankle joint.
Laboratory tests are unchanged. If necessary, consultations of related specialists are prescribed to determine the cause of arthrosis and differential diagnosis with other diseases: neurologist, rheumatologist, endocrinologist.

Radiography of the ankle joint. Severe arthrosis of the ankle joint and other joints of the foot.
Radiography of the ankle joint. Severe arthrosis of the ankle joint and other joints of the foot.
Treatment of arthrosis of the ankle joint
Treatment of pathology is long-term, complex. Usually, patients are observed by an orthopedic doctor on an outpatient basis. During the period of exacerbation, hospitalization in the department of traumatology and orthopedics is possible. The most important role in slowing the progression of osteoarthritis is played by lifestyle and the correct mode of motor activity, therefore, the patient is given recommendations for weight loss and optimizing the load on the leg.

Drug therapy
It is selected individually taking into account the stage of arthrosis, the severity of symptoms and concomitant diseases. Includes means of general and local action. The following groups of medicines are used:

NSAIDs of general action. Tablet forms are usually used. Indomethacin, meloxicam, diclofenac and their analogues are indicated during exacerbation. The drugs have a negative effect on the gastric mucosa, therefore, “sparing” medications (celecoxib, nimesulide) are preferred for gastrointestinal diseases.
Local NSAIDs. Recommended both in the period of exacerbation and in the remission phase. They can be prescribed as an alternative in case of side effects from tablet forms. They are available in the form of ointments and gels.
Chondroprotectors. Substances that contribute to the normalization of metabolic processes in cartilage tissue. They are used in the form of creams, gels and preparations for intra-articular administration. Medications containing glucosamine and collagen hydrolysate are used.
Hormonal agents. With severe pain syndrome, which cannot be stopped with the help of medications, intra-articular administration of corticosteroids is performed at intervals no more than 4 times a year.
Stimulators of metabolic processes. To improve local blood circulation and activate tissue metabolism, pentoxifylline and nicotinic acid are prescribed.
Physiotherapy treatment
The patient is prescribed a complex of physical therapy, developed taking into account the manifestations and stage of the disease. The patient is referred for physiotherapy. In the treatment of arthrosis, massage and UHF are used. In addition, in the treatment of pathology, they use:

laser therapy;
thermal procedures (ozokerite, paraffin),
medicinal electrophoresis and ultraphonophoresis.
Surgical treatment
It is shown in the late stages of the disease with the ineffectiveness of conservative therapy, severe pain syndrome, deterioration in the quality of life of patients, disability. Operations are carried out in stationary conditions, are open and minimally invasive:

Arthroscopic interventions. With significant destruction of cartilage, arthroscopic chondroplasty is performed. Sanation arthroscopy (removal of formations that hinder movement) is usually performed with severe pain at stage 2 of arthrosis. The effect persists for several years.
Arthrodesis of the ankle joint. It is produced with significant destruction of articular surfaces, provides for the removal of the joint and the “fusion” of the bones of the foot and lower leg. Provides restoration of the supporting function of the limb with loss of joint mobility.
Endoprosthetics of the ankle joint. It is performed when arthrosis is running. It includes the removal of destroyed articular surfaces of bones and their replacement with plastic, ceramic or metal prostheses. Movements are restored in full, the service life of the prosthesis is 20-25 years.

Forecast
Changes in the joint are irreversible, but the slow progression of arthrosis, the timely initiation of treatment and the implementation of the recommendations of an orthopedic traumatologist in most cases allow you to maintain working capacity and a high quality of life for decades after the first symptoms appear. With a rapid increase in pathological changes, endoprosthetics allows to avoid disability.

Prevention
Preventive measures provide for a reduction in the level of injuries, especially in winter, during the period of ice. In case of obesity, it is necessary to take measures to reduce body weight to reduce the load on the joint. It is necessary to maintain a regime of moderate physical activity, avoid overloads and microtraumas, timely treat diseases that can provoke the development of arthrosis of the ankle joint.

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