Osteoarthritis of the ankle is a degenerative-dystrophic damage to the cartilage plate of the joint and the underlying bone.
About the disease, exacerbation and progression of the process
The disease primarily begins with damage to the cartilaginous base of the joint. Under the influence of unfavorable factors, the cartilage becomes thinner, frays and tears, which contributes to the exposure of the underlying bone. During movements in the joint, the exposed bone experiences unphysiological stress and attempts to "protect itself". This leads to compensatory osteosclerosis (hardening) in the underlying subchondral zone as well as the development of secondary subchondral cysts. In response to this, the ideal relationships of theArticular surfaces are disturbed, which further aggravates the pathological process. As the disease progresses, the newly formed bone tissue forms growths (osteophytes) on the edges, which cause severe pain.
Deforming osteoarthritis of the ankle can be caused by various factors. These can be genetic, traumatic, growth and metabolic disorders. The initial destruction of the articular cartilage gradually leads to damage to the entire tissue of the synovial joints.
The main clinical signs of osteoarthritis are pain and limited mobility in the ankle joint. The disease is also characterized by the symptom of crepitus (crunch), the periodic appearance of effusion in the synovial cavity, as well as the secondary development of the inflammatory process. In addition to a clinical examination, ultrasound examinations of the joints and X-rays help to make the correct diagnosis. In complex cases, computed tomography or magnetic resonance imaging may be required.
Osteoarthritis of the ankle is usually treated using conservative methods. To improve the functional state of the cartilage plate, chondroprotectors are prescribed, including with an intra-articular route of administration. Nonsteroidal (and in particularly severe cases, steroidal) anti-inflammatory drugs help relieve pain. In cases of severe joint destruction, endoprosthesis replacement is carried out using third-generation prostheses that are completely integrated into the bone.
species
What does osteoarthritis of the ankle mean, taking into account the mechanisms of development? According to the classification, there are 2 variants of the disease:
- primary arthrosis, which is also called idiopathic, when even with the most modern examination it is not possible to determine the true cause of the disease;
- secondary arthrosis caused by the influence of one or more clearly defined causative factors listed above.
In clinical medicine there are 6 degrees of ankle arthrosis:
- In the first degree, the superficial zone of the cartilage is not damaged, but swelling and dissolution of the matrix occurs, the chondrocytes multiply and the type of collagen they synthesize changes (usually the cartilage plate is formed by collagen of the second type). and in arthrosis it is replaced by less durable collagen of the third type);
- in the second degree, the integrity of the superficial zone of the cartilage plate is disrupted, the location of chondrocytes in the deep zone changes;
- in the third degree, the progression of the pathological process leads to the appearance of vertical cracks;
- in the fourth degree, the superficial zone of the cartilage peels off, eroded surfaces and cysts appear;
- The fifth degree is characterized by the exposure of the underlying bone.
- In the sixth degree, compensatory changes occur in the bone tissue, consisting in its compaction, the formation of osteophytes and microfractures.
Symptoms
The main manifestation of ankle osteoarthritis is pain. The characteristic 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;
- mechanical in nature, leading to increased pain during physical activity and long walking;
- night aching pain caused by intraosseous stagnation of venous blood;
- Blockade pain is a pinch in the ankle, in which a person cannot bend or straighten the leg, because the pain increases significantly (the blockage occurs due to fragments of dead cartilage stuck between the articular surfaces);
- meteorological dependence - the pain increases when the weather changes, when it gets colder and the humidity increases.
Osteoarthritis of the ankle is a chronic process. Painful periods, indicating an exacerbation of the disease, alternate with painless ones. As osteoarthritis progresses, the time between attacks shortens and, at a certain stage, the pain can become permanent.
Causes of ankle osteoarthritis
On average, people over the age of 30 experience a gradual destruction of the cartilage plate that exceeds the rate of new cartilage formation. Therefore, the prevalence of the disease increases with age. There are also certain sexual characteristics. This protects the woman's joints from destruction before menopause. With the onset of the transition to menopause, the protective effect of estrogens gradually decreases, so from the age of 50, the frequency of pathologies in men and women is the same.
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:
- suffered traumatic injuries (jumping from a height poses 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, especially those affecting 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 cartilage layers;
- postmenopausal period (the average age of persistent absence of menstruation in women is 50-52 years);
- metabolic disorders;
- sedentary lifestyle;
- previous orthopedic surgery on the joint;
- repeated hypothermia.
diagnosis
If arthrosis of the ankle is suspected, the doctor recommends an additional research program. It can consist of the following methods:
- Ultrasound examination – the study allows assessing the condition of the soft tissue structures of the joint (cartilage, bursa and surrounding tissues). This is the most meaningful method for the early detection of changes in osteoarthritis;
- X-ray - this method primarily assesses the structure of bone tissue, helps to identify subchondral osteosclerosis and the presence of cysts in the subchondral zone, and also visualizes osteophytes (using X-ray to detect the first changes in arthrosis, mainly affecting the cartilage plate). , is extremely difficult).
In difficult clinical cases, computed tomography or magnetic resonance imaging can be used to provide a detailed assessment of the condition of the ankle joint. Any of these methods allows you to create layer-by-layer scans (scan step 2-3 mm) of the examination area and assess the condition of the intra- and extra-articular structures of the ankle.
Expert opinion
Studies have shown that hormones are actively involved in the growth and differentiation processes of cartilage tissue. Chondrocytes have been found to have receptors for thyroid hormones, insulin, glucocorticosteroids, growth hormones, male and female sex steroids, and prolactin. Disturbances in endocrine regulation are considered an important causative factor that can disrupt the balance between the process of cartilage formation and destruction, 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 osteoarthritis
The treatment of osteoarthritis in the initial stages is carried out using conservative methods. Timely therapy can protect the joint from destruction and delay or avoid surgical intervention altogether. If the disease is detected at the stage of significant destruction of the cartilage plate and is accompanied by stiffness that impairs human activity, endoprosthetics is indicated.
Conservative treatment
Conservative treatment of arthrosis begins with creating favorable conditions for the functioning of the joint. Recommended:
- Regular physiotherapy exercises, swimming and water aerobics are also useful;
- Normalization of body weight (if overweight);
- Use of crutches or orthopedic sticks during exacerbation of the process;
- Wear comfortable orthopedic shoes.
To improve the condition of the cartilage plate, chondroprotectors are used, which are injected mainly into the joint. Hyaluronic acid and PRP therapy (plasma therapy) restores the condition of the cartilage plate. Symptomatic treatment with non-steroidal anti-inflammatory drugs is used to relieve pain.
surgery
Replacement of the ankle joint is a rather complex task, so surgeons in a modern medical center strictly adhere to modern surgical methods that allow them to achieve the best therapeutic results. Currently, only third-generation implants are used in this operation, which require the removal of only a small bone fragment. These prostheses stimulate osteoclasts (cells that form bone tissue) so that they fuse well with the tibia, fibula and talus, providing special structural strength. A unique feature of the third generation prosthesis is that it allows movement of not only the main joint, but also the articulation between the fibula and tibia, thereby evenly distributing the load on the joint.
During ankle replacement surgery, existing deformities are also corrected and damaged ligaments are sutured. This creates favorable conditions to maintain the stability of the joint and fully ensure its functions.
Prevention of ankle osteoarthritis
Prevention of ankle arthrosis is to follow the following recommendations:
- Wear comfortable, non-compressive shoes and use orthotics.
- performing feasible physical exercises;
- Use of special ankle orthoses in professional sports;
- exclusion of jumping on feet from a height;
- timely correction of accompanying deformities of the lower extremities.
rehabilitation
After orthopedic surgery, the operated joint is temporarily immobilized. The period of immobility allows you to create optimal conditions for the restoration of bone tissue and helps the implant to integrate optimally. After removing the plaster cast, health-promoting gymnastics under the supervision of a physiotherapist, massage and physiotherapy are indicated.
questions and answers
Which doctor treats ankle osteoarthritis?
Diagnosis and treatment of the disease is carried out by a traumatologist-orthopedist.
What is arthrodesis?
Arthrodesis is a surgical option that has previously been used for ankle osteoarthritis. The operation involves immobilization of the joint, which has a negative effect on gait, but allows pain relief. Therefore, endoprosthesis replacement is considered a more optimal and physiological option for the surgical treatment of ankle osteoarthritis.
Is exercise possible after an 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.