Osteoarthritis of the ankle joint 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 begins primarily with damage to the cartilage base of the joint. Under the influence of adverse factors, the cartilage becomes thinner, fibers and cracks, which contributes to the exposure of the underlying bone. During movements in the joint, the exposed bone experiences a non-physiological load, so it tries to "protect itself". This provokes compensatory osteosclerosis (hardening) in the underlying subchondral zone, as well as the development of secondary subchondral cysts. In response, the ideal relationships are disturbedon the joint surfaces, 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.
Osteoarthritis of the ankle can be caused by a variety of factors. These can be genetic, traumatic, developmental and metabolic conditions. The initial destruction of the articular cartilage gradually leads to damage to all tissues of the synovial joints.
The main clinical signs of osteoarthritis are pain and limited mobility in the ankle. The disease is also characterized by a symptom of crepitus (crunching), periodic appearance of effusion in the synovial cavity, as well as secondary development of the inflammatory process. In addition to the clinical examination, ultrasound scanning of the joints and radiography help establish the correct diagnosis. In complex cases, computed tomography or nuclear magnetic resonance may be necessary.
Treatment of arthrosis of the ankle joint is usually carried out using conservative methods. To improve the functional state of the cartilage plate, chondroprotectors are prescribed, incl. with an intra-articular method of application. Nonsteroidal (and in particularly severe cases, steroidal) anti-inflammatory drugs help relieve pain. In case of severe destruction of the joint, endoprosthetics are performed with third-generation prostheses that are fully integrated with the bone.
Kinds
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 osteoarthritis, which is also called idiopathic, when it is not possible to establish the true cause of the disease even with the most modern research;
- secondary arthrosis, which is caused by the influence of a clearly defined causative factor or factors listed above.
In clinical medicine, there are 6 degrees of ankle arthrosis:
- in the first degree, the surface area of the cartilage is not damaged, but there is swelling and disintegration of the matrix, chondrocytes proliferate and the type of collagen synthesized by them changes (usually the cartilage plate is formed by collagen of the second type), and in arthrosis it is replaced by more- little durable collagen of the third type);
- in the second degree, the integrity of the surface zone of the cartilage plate is violated, 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 surface area of the cartilage peels off, eroded surfaces and cysts appear;
- the fifth degree is characterized by exposure of the underlying bone;
- at the sixth degree, compensatory changes occur in the bone tissue, which consist in its compaction, formation of osteophytes and microfractures.
Symptoms
The main manifestation of ankle arthrosis is pain. The distinctive features of the pain syndrome in this disease are:
- the initial nature of the pain, when it is most pronounced at the beginning of the movement;
- mechanical nature, which leads to increased pain during physical activity and long walking;
- night pain caused by intraosseous stagnation of venous blood;
- Blockage pain is a numbness in the ankle where a person can neither bend nor straighten the leg becausethe pain increases significantly (the blockage occurs due to the sticking of fragments of dead cartilage between the joint surfaces);
- weather dependence - the pain intensifies when the weather changes, when it gets cold and the air humidity increases.
Ankle arthrosis is a chronic process. Painful periods that indicate exacerbation of the disease alternate with painless ones. As arthrosis progresses, the period between relapses shortens, and at a certain stage the pain can become constant.
Causes of arthrosis of the ankle
On average, in people starting at the age of 30, there is a gradual destruction of the cartilage plate, which outpaces the rate of formation of new cartilage. Therefore, the prevalence of the disease increases with age. There are also certain gender characteristics. Thus, before menopause, women's joints are protected from destruction. With the onset of the menopausal transition, the protective effect of estrogens gradually decreases, therefore, starting from the age of 50, the frequency of pathology in men and women equalizes.
The following causes of arthrosis of the ankle joint have been 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 is particularly dangerous);
- previous inflammatory lesions of the joint;
- ankle deformities that may be associated with flat feet, varus or valgus position of the foot;
- hereditary collagenopathies, in particular those affecting collagen type 2 synthesis;
- ankle dysplasia;
- excess body weight, which increases the load on the ankle and contributes to the "attrition" of the cartilage layers;
- postmenopausal period (the average age of permanent cessation of menstruation in women is 50-52 years);
- metabolic disorders;
- sedentary way of life;
- previous orthopedic interventions on the joint;
- repeated hypothermia.
Diagnosis
If you suspect arthrosis of the ankle joint, the doctor recommends an additional examination program. It can consist of the following methods:
- Ultrasound scan - the study allows you to assess the condition of the structures of the soft tissues of the joint (cartilage, synovial bursa and surrounding tissues), this is the most informative method for early diagnosis of arthritic changes;
- X-ray - this method mainly evaluates the structure of bone tissue, helps to identify subchondral osteosclerosis, the presence of cysts in the subchondral area, as well as to visualize osteophytes (using X-rays to detect initial changes in osteoarthritis, mainly affecting the cartilage plate, is extremelyhard).
In severe clinical cases, computed tomography or nuclear magnetic resonance can be used to detail the condition of the ankle joint. Each of these methods allows you to obtain a layer-by-layer scan (scan step 2-3 mm) of the examined area and assess the condition of the intra- and extra-articular structures of the ankle.
Expert opinion
Studies show 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 hormone, male and female sex steroids, and prolactin. Disturbances of endocrine regulation are considered an important causative factor that can disrupt the balance between the process of cartilage formation and destruction, thus leading to dystrophy and degeneration. That is why it is so important to monitor the state of endocrine-metabolic reactions in the body, to conduct screening tests to assess the functional state of the thyroid gland and to contact an endocrinologist at the first suspicious symptoms.
Treatment of arthrosis of the ankle
Treatment of arthrosis in the initial stages is carried out using conservative methods. Timely therapy can protect the joint from destruction and delay or completely avoid the need for surgery. If the disease is detected at the stage of significant destruction of the cartilage plate and is accompanied by stiffness that interferes with human activity, endoprosthetics is indicated.
Conservative treatment
Conservative treatment of arthrosis begins with the creation of favorable conditions for the functioning of the joint. Recommended:
- regular physical therapy exercise, swimming and water aerobics are also helpful;
- normalization of body weight (if excess);
- use of crutches or orthopedic canes during exacerbation of the process;
- wearing comfortable orthopedic shoes.
To improve the condition of the cartilage plate, chondroprotectors are used, which are mainly injected into the joint. Hyaluronic acid and PRP (plasma therapy) therapy restores the condition of the cartilage plate. To relieve pain, symptomatic treatment with non-steroidal anti-inflammatory drugs is carried out.
surgery
Replacing the ankle joint is a rather complex task, so surgeons in a modern medical center strictly adhere to modern surgical methodology, which allows them to achieve the best therapeutic results. Currently, this operation only uses third-generation implants, which only require the removal of a small bone fragment. These prostheses stimulate osteoclasts (cells that form bone tissue) so that they fuse well with the tibia, fibula and talus, which provides 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 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 for preserving the stability of the joint and fully ensuring its functions.
Prevention of arthrosis of the ankle
Prevention of arthrosis of the ankle joint consists in observing the following recommendations:
- wearing comfortable and non-compressive shoes, using orthopedic insoles;
- performing doable physical exercises;
- use of special ankle braces in professional sports;
- exclusion of jumping on the feet from a height;
- timely correction of accompanying deformities of the lower limb.
Rehabilitation
After orthopedic intervention, 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 most fully. After removal of the plaster cast, therapeutic gymnastics under the supervision of a doctor of physical therapy, massage and physiotherapy is indicated.
Questions and Answers
Which doctor treats ankle arthrosis?
The diagnosis and treatment of the disease is carried out by a traumatologist-orthopedic.
What is arthrodesis?
Arthrodesis is a surgical option that has previously been used for ankle osteoarthritis. The operation involves immobilization of the joint, which negatively affects the gait, but allows pain relief. That is why endoprosthesis is considered a more optimal and physiological option for surgical treatment of ankle arthrosis.
Is it possible to play sports after ankle replacement?
After the installation of 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.