Osteoarthritis of the ankle joint is a degenerative-dystrophic lesion of the cartilage plate of the joint and the underlying bone.
Regarding the disease, deterioration and progression of the process
The disease mainly begins 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 joint movements, the exposed bone experiences a non-physiological load, so it tries to "protect itself". This provokes compensatory osteosclerosis (hardening) in the lower subchondral area, as well as the development of secondary subchondral cysts. In response, the ideal relations of the articular surfaces are broken, which further aggravates the pathological process. As the disease progresses, newly formed bone tissue forms growths (osteophytes) at the edges, which cause severe pain.
Deformative osteoarthritis of the ankle can be caused by various factors. These can be genetic, traumatic, developmental and metabolic. 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 the symptom of crepitus (cracking), the periodic appearance of effusion in the synovial cavity, as well as the secondary development of the inflammatory process. In addition to the clinical examination, ultrasound scanning of the joints and radiography help to establish the correct diagnosis. In complex cases, computed tomography or magnetic resonance imaging may be required.
Treatment of ankle arthrosis is usually carried out using conservative methods. To improve the functional condition of the cartilage 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, endoprosthesis replacement is performed using third generation prostheses, which are fully integrated with the bone.
The types
What does ankle arthrosis mean, considering 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 determine the true cause of the disease even with the most modern examination;
- secondary arthrosis, which is caused by the influence of a clearly defined causative factor or the 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 dissolution of the matrix, chondrocytes multiply and the type of collagen they synthesize changes (normally, the cartilage plate is formed by collagen of the second type. , and in arthrosis it is replaced byless stable collagen type three);
- in the second degree, the integrity of the surface zone of the cartilage plate is interrupted, 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, corroded surfaces and cysts appear;
- the fifth degree is characterized by exposure of the lower bone;
- in the sixth degree, compensatory changes occur in the bone tissue, which consist of its compression, the formation of osteophytes and microfractures.
Symptoms
The main manifestation of ankle arthrosis is pain. Distinctive features of the 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, leading to increased pain during physical activity and long walking;
- pain at night caused by intraosseous stagnation of venous blood;
- Blockage pain is a blockage in the ankle, in which a person cannot bend or straighten the leg, because the pain increases significantly (the blockage occurs due to the dead cartilage fragments getting stuck between the articular surfaces);
- meteorological dependence - the pain intensifies when the weather changes, when it becomes colder and the air humidity increases.
Ankle arthrosis is a chronic process. Painful periods, which indicate an aggravation of the disease, alternate with painless ones. As osteoarthritis progresses, the period between relapses shortens and at a certain stage the pain can become permanent.
Causes of ankle arthrosis
On average, in people starting at age 30, a gradual destruction of the cartilage plate occurs, 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 menopause transition, the protective effect of estrogens gradually decreases, therefore, starting from the age of 50, the incidence of pathology in men and women is equalized.
The following causes of ankle arthrosis 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 risk);
- 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 collagen type 2 synthesis;
- ankle dysplasia;
- excess body weight, which increases the load on the ankle and contributes to the "wiping out" of the cartilage layers;
- the post-menopausal period (the average age of permanent cessation of menstruation in women is 50-52 years);
- metabolic disorders;
- sedentary lifestyle;
- previous orthopedic interventions on joints;
- repeated hypothermia.
Diagnosing
If you suspect osteoarthritis of the ankle joint, the doctor recommends an additional research program. It can consist of the following methods:
- Ultrasound scan - the study allows you to assess the condition of the soft tissue structures of the joint (cartilage, synovial bursa and surrounding tissues), this is the most informative method for the early diagnosis of arthrosis changes;
- X-rays - 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 the visualization of osteophytes (using X-rays to detect the initial changes in osteoarthritis, which mainly affect the cartilage plate, is extremely difficult).
In difficult clinical cases, computed tomography or magnetic resonance can be used to detail the condition of the ankle joint. Each of these methods allows you to take layer-by-layer scans (scanning step 2-3 mm) of the area under study and assess the condition of the intra- and extra-articular structures of the ankle.
Expert opinion
Studies have shown that hormones take an active part in the processes of growth and differentiation of cartilage tissue. Chondrocytes have been shown to have receptors for thyroid hormones, insulin, glucocorticosteroids, growth hormone, male and female sex steroids, and prolactin. Disorders 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. Therefore, it is so important to monitor the state of endocrine-metabolic reactions in the body, perform screening examinations to assess the functional state of the thyroid gland and contact an endocrinologist at the first suspicious symptoms.
Treatment of ankle arthrosis
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 surgical intervention. 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 are indicated.
Conservative treatment
Conservative treatment of arthrosis begins with the creation of favorable conditions for joint functioning. Recommended:
- Regular physical therapy exercises, swimming and water aerobics are also beneficial;
- normalization of body weight (if it is excessive);
- the use of crutches or orthopedic canes during the deterioration of the process;
- wearing comfortable orthopedic shoes.
To improve the condition of the cartilage plate, chondroprotectors are used, which are mainly injected into the joints. Hyaluronic acid and PRP therapy (plasma therapy) restore the condition of the cartilage plate. To relieve pain, symptomatic treatment is carried out using 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 only a small fragment of bone. These prostheses stimulate osteoclasts (cells that form bone tissue), so they fuse well with the tibia, fibula and tailbone, 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 articulation between the fibula and the tibia, evenly distributing the load on the joint.
Ankle replacement surgery also involves correcting existing deformities and suturing damaged ligaments. This creates favorable conditions for maintaining the stability of the joint and fully ensuring its functions.
Prevention of ankle arthrosis
Prevention of ankle arthrosis consists in following the following recommendations:
- wearing comfortable and non-compressive shoes, using orthopedic insoles;
- performing feasible physical exercises;
- using special ankle braces when playing professional sports;
- exclusion of standing jumps from a height;
- timely correction of accompanying deformities of the lower limbs.
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After the orthopedic intervention, 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 more fully. After removing the cast, gymnastics for improving health under the supervision of a physiotherapist, massage and physiotherapy are indicated.
Question and answer
Which doctor treats ankle arthrosis?
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 arthrosis. The operation involves immobilization of the joint, which negatively affects walking, but allows pain relief. Therefore, endoprosthesis replacement is considered a more optimal 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 jogging. You should avoid high-impact sports - sprinting, football, tennis, wrestling.