Ankle arthritis

In recent years, experts around the world have noted an increase in degenerative-dystrophic processes in the ankles, which gradually lead to disability. Ankle arthritis often develops as a result of serious or permanent trauma in athletes, professional dancers, and circus performers. How to notice the signs of this disease in a timely manner and prevent its progression, as well as how to treat it, you will learn from this article.

Ankle arthritis - what is it?

The ankle is a complex, block-like joint formed by the lower (distal) ends of the tibia and fibula of the lower leg, forming the medial and lateral ankle (ankle), as well as the nail of the foot. . From the inside, it is strengthened by the deltoid ligament, from the outside - by the anterior and posterior cartilaginous and calcaneofibular ligaments. Function: flex and extend the foot. The ankle has the function of connecting to the foot, there are ligaments and tendons in common with the joints of the foot.

Osteoarthritis of the ankle is a degenerative-dystrophic disease that begins with the thinning and destruction of articular cartilage, reducing its wear-and-tear properties, followed by all other joint tissues in the pathological process. . The disease gradually leads to complete wear and tear of the joint. The ICD-10 code for dry arthritis of the ankle joint is M19.

This disease is less common than a similar knee injury and is usually the result of serious or long-term trauma from any activity.

Causes of ankle osteoarthritis

Specialist doctors have studied in detail the causes of ankle and foot osteoarthritis. This:

• trauma - intra-articular fracture, ankle fracture, complete and incomplete rupture of ligaments and tendons;
• minor injuries caused by any occupational activity - these are professional ballet dancers, dancers, athletes;
• increased load on the legs with excessive body weight;
• improper load distribution when wearing high heels;
• metabolic disorders that negatively affect the metabolism in cartilage tissue - diabetes, obesity, gout, . . . ;
• hormonal, including age-related changes;
• transfer severe acute purulent arthritis;
• long-term chronic arthritis of any origin;
• Lumbar osteochondrosis and herniated discs, which invade the spinal roots and weaken the muscles of the legs and feet, lead to joint instability and injury.

Mechanism of disease development (pathogenesis)

Under the influence of many different causes, the blood circulation in the joint is disturbed, leading to a decrease in the volume of synovial fluid that feeds the cartilage tissue. Due to lack of oxygen and nutrients, cartilage becomes thinner, cracks and corrosion appear on it. This leads to injury to the subchondral layer of the bone. It thickens (sclerotic) and grows along the edges of the joint surface. These growths are called osteoblasts. They compress soft tissues, blood vessels and nerves, causing pain and disrupting blood circulation.

Due to circulatory disorders and high stress, the muscles are damaged, they are weakened, leading to unstable joints and frequent dislocations. When arthritis of the feet develops, the small joints of the dorsal vertebrae, ankle joints, ankle joints, and intervertebral joints are affected.

Gradually, connective tissue develops in the joint, tightly aligning the joint surfaces and disrupting joint function. The complete loss of function of the ankle is associated with fusion of the joints. Arthritis of the feet also gradually develops.

Symptoms of ankle osteoarthritis

Osteoarthritis of the ankle is initially slow and not noticeable. But the symptoms gradually appear and increase, signaling some kind of violation in the lower extremities.

First sign

The first symptom of ankle arthritis is pain when subjected to high loads, such as when walking for a long time, dancing, playing soccer or volleyball, etc. v. This pain passes quickly so the patient does not notice it immediately, thinking it is due to muscle fatigue. Pain can be both symmetric (when subjected to high loads and side effects) and unilateral (after a major trauma).

This is followed by a feeling of stiffness in the morning or after a long period of immobility. A stiff ankle makes movement difficult. In the early stages, it lasts a few minutes and passes after a slow tempo. This symptom was warned and became a reason to see a doctor.

Overt symptoms

Gradually, the pain after exertion increases, and lasts longer. Feet can be sore all day. The pain occurs at night, they usually appear in the second half of the night and are sometimes accompanied by painful cramps. The periods of stiffness after immobilization also last longer.

Due to the intense pain, a person begins to limp while walking, trying to relieve pain in the foot by stretching or pressing on the foot. Sometimes the ankle swells, the skin reddens, the pain is more intense. This is a sign of bursitis - an inflammation of the inner synovial membrane. Inflammation is non-infectious in nature, develops from mechanical irritation and resolves on its own without treatment. But at the same time, exacerbation of bursitis triggers the progression of degenerative joint processes.

Danger symptoms

Persistent pain, worsening with exertion, instability, joint laxity, tendency to dislocation, dislocation, and ligament injury are dangerous symptoms that require medical attention. The ankle changes externally: it has a different shape due to the overgrowth of bone cells. Arthritis of the ankle (ankle) leads to thickening. The movements of the foot are limited at first, then the ankle is immobile or, conversely, loose and unstable. But even at this stage, the patient can be helped, you just need to contact the clinic. Symptoms of arthropathy of the feet appear: pain in the foot, violation of its flexion and loss of value. The big toe joint develops with pain and deformity in the form of bulging and curving of the big toe.

What is dangerous ankle joint disease?

The danger is that the disease is not easy to recognize at first, and patients often go to the doctor when it has progressed to a severe stage.

Any localization and form of arthritis has serious complications, so you should not delay treatment.

Classify

Ankle arthritis can be primary, when its developmental cause is unknown, and secondary, with an obvious cause of origin. Depending on the cause of development, the disease can have its own distinctive features.

Post-traumatic ankle arthritis

Consequences of traumatic injury are the most common cause of disease. Posttraumatic ankle arthritis can develop after a major injury - ligament rupture, dislocation, fracture in the joint. Often one joint is injured, so posttraumatic osteoarthritis is unilateral. A minor but untreated injury may not feel at first on its own. And only after a while, when a person has forgotten about it, a slight pain gradually appears. This type of injury is dangerous because the patient comes to the doctor in a neglected state. Serious injuries are better treated, their consequences appear quicker, and it's not too late for patients to seek medical help.

Small, subtle long-term injuries to both ankles are typical for professional dancers, athletes, and those whose occupations involve long periods of time on their feet. There is symmetrical pain in the ankle with exertion. They often confuse muscle pain with fatigue, so it's too late to see a doctor.

Post-arthritis ankle arthritis

The causes of these joint diseases can be chronic inflammatory processes in the joints (arthritis): rheumatic, reactive, psoriatic. In this case, inflammatory processes are combined with degenerative-dystrophic (arthritis-arthritis). This accelerates the destruction of the ankle. During acute inflammation, the joints swell, the skin reddens, the pain becomes very intense, especially at night. When the inflammation subsides, metabolic disturbances prevail, while all processes develop very rapidly. The disease needs to be continuously monitored and treated by a rheumatologist.

Less often, degenerative-dystrophic processes develop after acute purulent arthritis. The pyogenic process destroys the joint tissues, and after recovery, connective tissue is formed in their place, disrupting the function of the extremities.

Arthritis can also form after septic arthritis - tuberculosis, gonorrhea, etc. The progression of the disease is closely related to the primary infectious process and the nature of its destruction. If the infection persists, joint destruction will progress.

Metabolically

Developed with a long course of gout. Very often the first toe is affected. Other small joints of the feet and ankles are less affected. Because gout attacks continue, it is difficult to externally determine when the degenerative-dystrophic process occurs. You can only see it on x-rays. In all cases, patients should be regularly monitored and examined by a rheumatologist.

Deformity of ankle joint

All types of joint disease become disfiguring over time. Bone deformity indicates an advanced stage of disease, when the cartilage has collapsed and the continuous mechanical impact on the bone tissue contributes to cartilage growth along the edges of the joint surface. This is how bone-forming substances are formed that change the shape of the joint.

Degree of ankle osteoarthritis

There are several classifications, one of which distinguishes three clinical and radiological stages of arthropathy:

1. Early. A little pain after standing or walking for a long time, some stiffness in the morning. All this disappears quickly without any help. X-ray: normal or mild joint space stenosis.
2. progressive. Pain after exertion is stronger and lasts longer. Stiffness increases, there is a crunching sound in the joints when moving. Sometimes the joint is swollen, red and painful - a sign of bursitis. X-rays show significant narrowing of joint space, thickening of subchondral bone tissue (osteofibrosis) and proliferation of osteoblasts.
3. Final. The pain syndrome gradually increases, becoming permanent. Because of the pain, a person limps, flexes his legs, uses a cane or crutches. Impaired limb function, development of the joints of the feet and toes. The complete absence of flexion-extension movements is rare, often occurring against the background of arthropathy-arthritis. On X-ray: there is no joint space, there are fibrous foci, large bones deform the joint.

Possible complications

If the disease is left untreated and let things take their natural course, the following complications can occur:

• persistent dysfunction of joints and disability;
• severe pain that does not stop in the ankle and foot, both after exertion and without pain;
• instability of the ankle with the development of subluxation and subluxation;
• damage to the foot and toe will be involved, which will aggravate the patient's condition.

Diagnosis of joint disease of the ankle

Before prescribing treatment, the doctor conducts examination for the patient, including:

• interview and medical examination;
• additional research methods: laboratory tests (detection of inflammatory markers and metabolic disorders), instrumental studies (joint radiographs in two projections, computer and magnetic resonance imaging -detect early changes in bone structure and soft tissue), diagnostic arthroscopy (internal joint surfaces are examined).

Treatment of ankle arthritis

After establishing the final diagnosis, the doctor selects an individual treatment complex for the patient, including pharmacological and non-pharmacological methods.

Medical treatment of ankle osteoarthritis

The drug is prescribed with a symptomatic (eliminates the symptoms of the disease) and a pathogenic (stops the mechanism of the development of the disease).

Anti-inflammatory and pain reliever

To eliminate pain, drugs from the group of non-steroidal anti-inflammatory drugs (NSAIDs) are prescribed in short courses, they relieve pain and inflammation well (if the bursitis worsens):

• injections;
• rectal suppositories;
• pillets for drink;
• skin patch.

Muscle relaxants

The muscles around the diseased joint and carrying out its movement are under constant tension, leading to atrophy and increased pain. To eliminate muscle spasms, drugs from the group of muscle relaxants are prescribed.

Chondroprotectors

Medicines from the group of chondroprotectors contain glucosamine or chondroitin, and sometimes both. They protect the cartilage cells from destruction and promote their recovery. They are prescribed in the form of injections, tablets and external agents (creams and ointments).

Hyaluronic acid preparations for the treatment of arthritis of the ankle joint

To improve the buffering capacity of synovial fluid and prevent further damage to cartilage and bone tissues, hyaluronic acid is injected into the joint cavity. This helps reduce pain and improve joint mobility.

Gels and ointments against osteoarthritis of the ankle

External means can be used at home. Ointment for arthritis of the ankle joint:

• NSAID gel is suitable for pain and inflammation;
• for cartilage restoration - gels and ointments based on chondroitin.

Non-drug therapy

The main methods of treating ankle joints are non-pharmacological. These are therapeutic exercises, massage, physical therapy, wearing orthopedic devices.

Physical therapy

To alleviate the patient's condition and restore joint function, appoint:

• drug electrophoresis;
• laser therapy;
• acupuncture therapy;
• warming process - paraffin, ozocerite, in the conditions of resorts - slurry application.

Massage treatment for ankle osteoarthritis

Massage courses help improve blood circulation, which leads to the activation of metabolism, the restoration of joint and extra-articular tissues. The positive effect of massage on muscles is to eliminate spasms, contribute to promoting blood flow to the muscles and restore their strength, which is necessary to keep the limbs in the desired position.

Exercises and exercise therapy for ankle arthritis

Gymnastics is a panacea for joint disease. Physical activity is very important, in addition to exercise therapy, swimming is very useful. The systematic implementation of exercises selected by the doctor allows you to restore most of the function of the limb, even if the disease has progressed.

An approximate set of exercises (but before starting to do them, you need to consult a doctor):

Use special orthopedic products

To prevent the progression of the disease, the doctor may prescribe wearing a special orthopedic device - an orthopedic device. It fixes the leg in the correct anatomical position, relieves muscle tension, improves blood circulation. The wearing of an orthotic is prescribed by a doctor, who also chooses the most suitable model.

Fixation of the ankle can also be done using adhesive tape: with special adhesive tape, the ankle is gently fixed in the desired position.

Surgical intervention

Surgery is recommended for severe pain that cannot be eliminated with conservative treatments, as well as for cases of significant limb dysfunction.

Types of surgical interventions

Activities can be done in traditional and gentle ways:

1. Arthroscopy therapy (saving operations):
   • cleaning of the joint cavity - with the help of arthroscopy, fragments of cartilage and bone tissue are removed from the cavity, which interfere with movement and cause pain;
   • chondroplasty - the damaged cartilage layer is removed, which stimulates the growth of new chondrocytes (chondroplasty); in some cases, implantation of autologous cartilages taken from unloaded areas of the patient's knee joint (mosaic arthroplasty) is performed; chondroplasty is effective in the second stage of the disease, when the joint has not yet lost function.
2. Arthrodesis is a traditional surgery. It is performed with a significant violation of the function of the extremities, laxity, dislocation and habitual pain. The joint is removed, the bones of the lower leg are fused with the bones of the foot. The ankle becomes immobile and acts only as a support.
3. Laparoscopy is the replacement of a worn and dysfunctional ankle with an artificial eye.

Features of rehabilitation after surgery

All operations are carried out in static conditions, after which experts recommend full recovery. With sparing operations, rehabilitation is performed on an outpatient basis with early introduction of therapeutic exercises except for high loads on the joints. After endoscopy, the patient stays in the hospital for a week, and then rehabilitation measures are performed on an outpatient basis. After two weeks, the stitches are removed and the patient can shower.

Diet food

There is no special diet for osteoarthritis. But to eliminate unnecessary stress on the ankle, it is necessary to maintain a normal body weight. A person should receive proper healthy nutrition, but the mass of high-calorie foods should be partially replaced with vegetables and fruits. The first and second low-fat dishes, chicken, sea fish, cheeses, cheeses, dairy products are very useful.

Traditional medicine

Using only traditional medicine to treat arthritis will not work. But they can be used as part of a complex treatment prescribed by your doctor. Here are some recipes:

• for oral administration: infusion of wild rosemary; Pour 20 g of chopped grass overnight in a thermos with 500 ml of boiling water, filter the water to drink in the morning, drink half a glass, 4 times a day for a month; relieve pain, restore cartilage tissue;
• Oral administration: Take 0. 5 cm diameter marbles in the morning, chew well, 30 minutes before meals, for 10 days; take a 5 day break, then repeat everything 3 more times; excellent stimulant of metabolism;
• honey massage: apply warm liquid honey to the ankles before going to bed and gently massage, massaging the tissues, for 5 minutes; then wrap your feet in a warm shawl and leave it on until morning; restores blood circulation and metabolism in cartilage tissue.

Methods of treatment in the clinic

The doctors at the clinic have developed their own approach to treating conditions such as ankle and foot arthritis. During the initial appointment, the doctor will conduct a thorough examination of the patient, listen to their complaints and medical history, and then prescribe additional laboratory and instrumental tests, including imaging tests. MRI. Only then the doctor establishes the final diagnosis, prescribes and agrees with the patient on the complex treatment. It includes:

• modern joint treatment program with drugs and non-pharmaceuticals - drugs, physical therapy, therapeutic exercise and massage, methods of ankle immobilization;
• traditional methods of oriental medicine - acupuncture, massage, acupressure, various kinetic therapies, including compression bandages.

These are not all methods used in the clinic. Doctors have the ability to combine Western and Eastern medicine methods, rapidly promoting the improvement of the patient's condition markedly. Patients quickly get rid of pain, quality of life is significantly improved.

Combines the proven techniques of the East and the innovative methods of Western medicine.

Prevention of foot joint disease

To reduce the risk of disease progression, the following recommendations should be adhered to:

• being active, doing therapeutic exercises, swimming should become a part of your life;
• high physical activity and any traumatic factors should be excluded; hiking should be combined with rest, if the leg is injured during work, it should be changed;
• injuries, especially in winter on ice, should be ruled out by thinking about the way the movement and shoes are used;
• proper nutrition is necessary to restore metabolism, but being overweight is an extra burden on the ankles, let's get rid of it;
• Preventive treatment courses are a guarantee for pain-free life.

Frequently asked questions about the disease

1. Which doctor should I contact for treatment of osteoarthritis of the ankle and foot?

   Send an orthopedic doctor. But if the disease develops against the background of some kind of rheumatic process, then visit a rheumatologist.

2. What predictions do doctors usually make?

   It is possible to stop the progression of the degenerative process and improve the quality of life at any stage, but it is best to do this in the early stages of the disease, without waiting for complications to appear.

3. Can osteoarthritis in children be cured?

   It is possible after an injury or against the background of a congenital pathology.

4. What are the consequences of the disease?

   Untreated joint disease can lead to disability. If you start treatment in time, you can completely preserve the function of the limb. Treatment in the later stages will reduce pain and improve quality of life.

5. Are sports injuries the cause of ankle osteoarthritis?

   Yes, sports injuries are one of the main causes of this disease.

6. Can ankle bandages be performed with arthritis?

   It is entirely possible, but this should be done by a specialist.

Ankle arthritis is almost always the result of a macroscopic or microscopic injury. At first, it was slow and inconspicuous. Therefore, prompt treatment and rehabilitation after an injury is very important, as well as contacting a doctor at the first signs of ankle disease.