Ankle arthrosis is a degenerative, dystrophic disease of the structures of the musculoskeletal system. It affects the lower limbs. It is considered one of the most common forms of arthrosis: it accounts for up to 30% of the total number of cases of degenerative-dystrophic joint damage. The pathological process occurs not only in elderly patients. About a quarter of patients are people under 40 years old.
The disorder is associated with constant pain and a gradual decline in joint and lower limb function. Without treatment it progresses and does not go away on its own. The diagnosis and treatment of the disorder is the work of the orthopedic doctor (depending on the cause, the traumatologist, physiotherapy doctors and physiotherapists are included).
Causes of ankle arthrosis
Osteoarthritis is considered a polyetiological disease. Its development occurs as a result of the influence of a group of causes. With age, the number of provoking factors of the disease increases, thus increasing the likelihood of a pathological process. But not everything is so simple.
Pathogenesis of the disorder
There are a number of causes of ankle arthrosis, the most common of which are:
- irrational physical activity;
- injuries;
- operations;
- metabolic diseases;
- uncomfortable shoes;
- other diseases of the musculoskeletal system;
- rheumatoid diseases.
Irrational stress can be a result of lifestyle or a consequence of the choice of profession. Continuous walking, standing in one place, carrying heavy objects, intense activity. All of these are provocateurs of the pathological process in the medium term (several years).
Another reason is injuries, especially intra-articular fractures, dislocations and also severe bruises (to a lesser extent). Osteoarthritis of the ankle appears unnoticed, but constantly progresses. Patients often underestimate the consequences of the trauma they have suffered.
Operations can provoke arthrosis. However, such a complication is relatively rare. Mainly due to a wrong assessment of the clinical situation. insufficient qualification of the doctor.
Metabolic pathologies, such as diabetes mellitus, can provoke a disorder. However, much more often the causes of ankle arthrosis are gout, as well as hormonal disorders (for example, during menopause).
Uncomfortable shoes are one of the main factors in the development of the pathological process. The disorder develops due to the improper distribution of the load on the foot. Complex disorders usually develop: not only arthrosis, but also spinal injuries. At a minimum - osteochondrosis. But more dangerous problems are also possible.
Musculoskeletal system dysfunctions themselves also increase the likelihood of a pathological process. Intervertebral hernias, osteochondrosis and congenital disorders create additional risks.
Rheumatoid diseases are represented by arthritis, systemic lupus erythematosus. Degenerative-dystrophic lesions are secondary, but they aggravate the underlying disease and worsen the prognosis.
Ankle arthrosis is a multifactorial disease. As a rule, it develops under the influence of several causes at the same time. There are exceptions, but they are rare. Also, the number of factors affects the severity of the disease and the rate of progression of the pathological process.
The development of the pathological process is step by step. In the initial stage, local blood circulation and distribution of dynamic load on the leg are interrupted. Gradually, the destructive processes in the cartilage increase. Slow inflammation begins. Degeneration of other ankle structures occurs: capsule, ligaments, bones, etc. The more advanced the disease, the more difficult the treatment. It requires more effort and time.
Factors increasing the risk of developing arthrosis
Dystrophic destruction of ankle tissues occurs not only as a result of the influence of immediate causes. The severity, likelihood of the disease and the nature of its course are influenced by risk factors. They complete the offense picture. Among them:
- the habit of wearing heels;
- the physically demanding nature of work (including professions with invisible risks: teachers, cooks also get sick);
- previous injuries of the ankle joint (there are cases when the disorder appeared years after the injury);
- history of endocrine diseases (hormonal disorders create additional risks);
- history of musculoskeletal diseases;
- age 40+ (although the disease also occurs in young people);
- increase in body weight;
- gender (women suffer more often than men).
Ankle arthrosis is a disease that develops slowly; symptoms do not become apparent immediately. Therefore, it is difficult to assess which risk factors and causes provoke the pathological process. It is necessary to collect a complete medical history.
Classification and types of ankle joint injury
Pathology is classified according to two bases.
The first criterion is the origin of the pathological process. I emphasize:
- post-traumatic form of the disorder (develops after injuries to the ankle joint or other structures of the musculoskeletal system);
- deforming arthrosis of the ankle joint: consequence of metabolic disorders or injuries, accompanied by slow but stable deformation of the joint;
- Metabolic arthrosis develops against the background of diabetes, hormonal disorders or gout (disorders of purine metabolism).
The second basis for classification is based on the stage of the pathological process. In its development, ankle arthrosis goes through the following stages:
- initial or early;
- progressive;
- advanced arthrosis.
In the first stage, there is no clinical picture as such or it appears after intense physical activity. The pathological process is detected only with the help of special diagnostic methods.
The progressive phase of the disorder is associated with an intensification of the clinic. Symptoms appear after light physical activity. Load tolerance decreases. There is a constant pain syndrome, as well as limited mobility of the leg in the ankle joint.
The final stage of the pathological process is accompanied by severe pain, as well as other symptoms in a state of complete rest. Both supportive and motor functions are impaired. Often a person becomes disabled. Complex surgical treatment is required, including endoprosthetics.
Important!
Staging plays the biggest role in determining treatment tactics and predicting the course and outcome of the disease. The disorder is best treated at an early stage. The more advanced the pathology, the more difficult and longer the correction.
Symptoms of the disorder
The clinical framework depends on the form and stage of the pathological process. Typical manifestations are:
- pain;
- fatigue;
- exercise intolerance;
- swelling;
- disorders of the supporting function of the leg;
- muscle weakness.
Leg pain is first noticed only after intense physical activity. Then a little activity is enough. In the advanced stage of the pathological process, pain is always present, regardless of the load.
Fatigue is observed in the first stage of the disorder. The feeling of muscle weakness and increased fatigue progresses along with the disease. Signs indicate further development of the disorder.
Exercise tolerance also gradually decreases. At a pronounced stage of the disorder, a person cannot rise to the second or third floor. We have to make stops.
Swelling is a sign that is always present. The foot at the ankle appears swollen and enlarged. This is a non-specific manifestation.
Initial pain is typical. After a long stay in one place, severe joint stiffness develops. The first moves cause a lot of anxiety. Pain and discomfort gradually disappear as the person continues to move.
The clinical picture depends on the degree of ankle arthrosis. It plays a major role in determining the stage and severity of the pathological process. The physician systematizes symptoms through a process of oral questioning and history taking.
The disease is characterized by a chronic course. During periods of deterioration, the signs of ankle arthrosis appear more clearly. In the chronic phase, remission is only partial. The clinic is not so bright, but the symptoms do not go away completely. Then a new worsening of ankle arthrosis occurs, the manifestations again become intense. And so on in a circle until quality treatment is performed.
Complications of ankle arthrosis
Complications of the pathological process are related to maintaining working capacity and the ability to take care of oneself.
Patients experience ankle deformities. The pathological process ends with the formation of contractures, areas of primary or complete limb immobility in the ankle. The situation can only be corrected surgically.
At the time of exacerbation, the development of synovitis and inflammation of the synovial bursa is typical. This condition lasts several weeks and during its acute course completely eliminates the ability to work and move.
The final result of the pathological process is a decline and then a complete loss of the supporting function of the leg; the person cannot move normally. You must use crutches. There is a complete loss of the ability to work, and in some cases, the ability to take care of oneself. In advanced stages of ankle arthrosis, patients become disabled.
Diagnosis of the disease
The diagnosis of damage to articular structures and cartilage tissue is carried out under the supervision of an orthopedic traumatologist. Examinations are typical. It is not difficult to identify the pathological process, as well as the degree of its severity. Among the techniques:
- oral questioning of the patient to better understand the nature of symptoms and health complaints;
- collection of anamnesis, which allows you to determine the possible origin of the pathological condition;
- palpation: arthrosis is indicated by deformation, swelling, pain during passive movements;
- X-ray of the ankle: a routine examination that provides enough information to establish a diagnosis and determine its severity, is considered the gold standard examination;
- MRI if radiographic data are insufficient.
Other studies may be conducted. For example, computed tomography (arthrosis affects not only the cartilage, but also the bones; CT allows detailed and accurate visualization of the nature of the disorders).
Note!
Arthrosis has no specific manifestations, especially at an early stage. Therefore, without sufficient knowledge, it will not be possible to distinguish pathological processes from each other. Special instrumental diagnostics is required.
Laboratory diagnostic techniques provide few clues. They are only informative in terms of identifying the inflammatory process and help in the diagnosis of some forms of arthrosis (metabolic origin, rheumatoid nature).
Treatment methods
Treatment of ankle arthrosis is carried out using conservative and surgical techniques. The best results can be achieved if you resort to complex correction.
Conservative therapy includes the use of medications, exercise therapy and physiotherapy with massage. The following drugs are used:
- local anti-inflammatory;
- general anti-inflammatory drugs (in the form of tablets or solutions for injection);
- chondroprotectors;
- nicotinic acid and other means to improve metabolic processes.
Exercise therapy and physiotherapy, along with massage, are aimed at recovery after the acute condition has been eliminated. These methods are important during the remission period. If the disease appears in an acute form with pronounced clinical symptoms, the methods are postponed.
Surgical treatment is required for persistent deformities and deviations in joint anatomy. Joint plastic surgery or endoprosthetics, joint replacement with an artificial analogue are possible. This is a high-tech correction method.
prediction
Prognosis depends on the moment of treatment, health condition, cause of arthrosis, as well as the degree of development of the disorder. The more advanced the disease, the more complicated the situation. If treatment is started early, the prospects for recovery and full recovery are good. In other cases, surgery and a long period of rehabilitation are required.
Prevention of disorder
Prevention of ankle arthrosis includes:
- wearing comfortable shoes;
- timely treatment of musculoskeletal diseases;
- reasonable welfare check;
- body weight control;
- avoiding injuries;
- load control.
Prevention can reduce the risk of ankle arthrosis by 2-3 times. The possibility of a pathological process will be minimal.