Arthrosis of the ankle joint is a degenerative-dystrophic lesion of the cartilaginous plate of the joint and the underlying bone.
About the disease, exacerbation and progression of the process
The disease begins mainly with damage to the cartilaginous base of the joint. Under the influence of unfavorable factors, the cartilage becomes thinner, with 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 causes compensatory osteosclerosis (hardening) in the underlying subchondral zone, as well as the development of secondary subchondral cysts. In response, the ideal relationships of the articular surfaces are disturbed, which further aggravates the pathological process. As the disease progresses, the newly formed bone tissue forms growths (osteophytes) at the edges, which cause severe pain.
Deforming osteoarthritis of the ankle can be caused by several factors. These can be genetic, traumatic, growth and metabolic conditions. The initial destruction of 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 the symptom of crepitation (popping), periodic appearance of effusion in the synovial cavity, as well as secondary development of the inflammatory process. In addition to clinical examination, joint ultrasound and radiography help to 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 by conservative methods. To improve the functional state of the cartilaginous plate, chondroprotectors are prescribed, incl. with an intra-articular route of administration. Nonsteroidal anti-inflammatory drugs (and in particularly severe cases, steroids) help relieve pain. In case of severe destruction of the joint, the endoprosthesis is replaced with third-generation prostheses, fully integrated into 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 osteoarthritis, also called idiopathic, when it is not possible to establish the true cause of the disease even with the most modern tests;
- secondary arthrosis, which is caused by the influence of a clearly defined causal factor or the 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 there is swelling and disintegration of the matrix, 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);
- at the second degree, the integrity of the superficial zone of the cartilaginous plate is disturbed, 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 detaches, eroded surfaces and cysts appear;
- the fifth degree is characterized by exposure of the underlying bone;
- in 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 osteoarthritis is pain. Distinctive features of pain syndrome in this disease are:
- the initial nature of the pain, when it is more pronounced at the beginning of the movement;
- mechanical in nature, which leads to increased pain during physical activities and long walks;
- night pain caused by intraosseous stagnation of venous blood;
- blockage pain is a tightness in the ankle, in which the person cannot bend or straighten the leg, because the pain increases significantly (the blockage occurs due to fragments of dead cartilage that are trapped between the articular surfaces);
- meteorological dependence - the pain intensifies when the weather changes, when it becomes colder and the air humidity increases.
Ankle osteoarthritis is a chronic process. Painful periods, which indicate an exacerbation of the disease, alternate with painless periods. As osteoarthritis progresses, the period between relapses shortens and, at a certain point, the pain may become permanent.
Causes of ankle osteoarthritis
On average, in people over 30 years of age, there is a gradual destruction of the cartilaginous plate, which exceeds 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 beginning of the menopausal transition, the protective effect of estrogens gradually decreases, therefore, after the age of 50, the incidence 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 cartilaginous tissue does not have time to cover the catabolism (destruction) of cartilage:
- 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 interventions on the joint;
- repeated hypothermia.
Diagnosis
If you suspect osteoarthritis of the ankle joint, the doctor recommends a further research program. It may consist of the following methods:
- Ultrasound - the study makes it possible to assess the state of the soft tissue structures of the joint (cartilage, synovial sac and adjacent tissues), being the most informative method for the early diagnosis of osteoarthritis changes;
- X-ray - this method mainly assesses the structure of bone tissue, helps to identify subchondral osteosclerosis, the presence of cysts in the subchondral zone, and also to visualize osteophytes (using X-rays to detect initial changes in osteoarthritis, affecting mainly the cartilaginous plate, is extremely hard).
In difficult clinical cases, CT or MRI can be used to detail the condition of the ankle joint. Each of these methods allows you to obtain layer-by-layer scans (scan step 2-3 mm) of the area under study and assess the condition of the intra- and extra-articular structures of the ankle.
Opinion of an 'expert
Studies have shown that hormones actively participate in the growth and differentiation processes of cartilaginous 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 disturb the balance between the process of cartilage formation and destruction, leading to dystrophy and degeneration. Therefore, it is very important to monitor the state of endocrine-metabolic reactions in the body, carry out screening tests to assess the functional state of the thyroid gland and contact an endocrinologist at the first suspicious symptoms.
Treatment of ankle osteoarthritis
Treatment of arthrosis in the early stages is carried out using conservative methods. Timely therapy can protect the joint from destruction and delay or completely avoid the need for surgical intervention. If the disease is detected at 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 osteoarthritis begins with creating favorable conditions for the joint to function. Recommended:
- regular physiotherapy, swimming and water aerobics exercises are also helpful;
- normalization of body weight (if it is excessive);
- use of crutches or orthopedic canes during an exacerbation of the process;
- wearing comfortable orthopedic shoes.
To improve the condition of the cartilaginous plate, chondroprotectors are used, which are injected mainly into the joint. Therapy with hyaluronic acid and PRP (plasma therapy) restores the condition of the cartilaginous plate. To relieve pain, symptomatic treatment is carried out with non-steroidal anti-inflammatory drugs.
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 require the removal of just a small bone fragment. These prostheses stimulate osteoclasts (cells that form bone tissue), which is why they fuse well with the tibia, fibula and talus, which guarantees special structural resistance. 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.
Surgical intervention for ankle replacement 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.
Ankle osteoarthritis prevention
Prevention of arthrosis of the ankle joint consists of following the following recommendations:
- wear comfortable, non-compressive shoes, use orthopedic insoles;
- perform viable physical exercises;
- use of special ankle bracelets when practicing professional sports;
- exclusion from high jumping;
- timely correction of concomitant 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 ideal conditions for the restoration of bone tissue and helps the implant to integrate more completely. After removing the plaster, recreational gymnastics under the supervision of a physiotherapist, massage and physiotherapy are recommended.
Questions and answers
Which doctor treats ankle osteoarthritis?
Diagnosis and treatment of the disease are carried out by a traumatologist-orthopedist.
What is arthrodesis?
Arthrodesis is a surgical option previously used for ankle arthrosis. The operation involves immobilizing the joint, which negatively affects gait but allows pain relief. Therefore, endoprosthesis replacement is considered a more ideal and physiological option for the surgical treatment of ankle osteoarthritis.
Is it possible to play sports after ankle replacement?
After installing a third generation implant, a person can engage in "soft" sports - skiing, swimming, cycling and light running. You should avoid high-impact sports – fast running, football, tennis, wrestling.