Osteoarthritis 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 primarily with damage to the cartilaginous base of the joint. Under the influence of unfavorable factors, cartilage thins, becomes fibrous and cracks, which contributes to the exposure of the underlying bone. During joint movements, the exposed bone experiences non-physiological loading, so it tries to "protect itself. "This causes compensatory osteosclerosis (hardening) in the underlying subchondral area, as well as the development of secondary subchondral cysts. In response, the ideal relationships of the articular surfaces are disturbed, further aggravating the pathological process. As the disease progresses, newly formed bone tissue forms growths (osteophytes) at the edges, causing 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 synovial joint tissues.
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 effusions in the synovial cavity, as well as the secondary development of the inflammatory process. In addition to clinical examination, ultrasound of the joints and x-ray help establish the correct diagnosis. In complex cases, a CT scan or MRI may be necessary.
Treatment of osteoarthritis 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 route of administration. Non-steroidal anti-inflammatory drugs (and in particularly severe cases, steroids) help relieve pain. In case of severe destruction of the joint, replacement of the endoprosthesis is carried out using third-generation prostheses, which are completely integrated with the bone.
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What does osteoarthritis 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 examination;
- secondary osteoarthritis, which is caused by the influence of a clearly defined causal factor or factors listed above.
In clinical medicine, there are 6 degrees of ankle osteoarthritis:
- 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 cartilage plate is formed by collagen of the second type, and in osteoarthritis is replaced by less durable collagen of the third type);
- in 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 area of the cartilage detaches, eroded surfaces and cysts appear;
- the fifth degree is characterized by exposure of the underlying bone;
- In the sixth grade, compensatory changes occur in the bone tissue, which consist of its compaction, the 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 most pronounced at the beginning of movement;
- mechanical in nature, causing increased pain during physical activity and long walks;
- night pain caused by intraosseous stagnation of venous blood;
- Locking pain is a jam in the ankle, in which a person cannot bend or straighten the leg, becausethe pain increases significantly (the lock occurs due to fragments of dead cartilage becoming trapped between the articular surfaces);
- Weather dependence: the pain intensifies when the weather changes, when it gets colder and the humidity of the air increases.
Ankle osteoarthritis is a chronic process. Painful periods, which indicate an exacerbation of the disease, alternate with painless ones. As osteoarthritis progresses, the period between relapses becomes shorter, and at some point the pain may become permanent.
Causes of ankle osteoarthritis.
On average, in people from the age of 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, a woman's joints are protected from destruction. With the onset of the menopausal transition, the protective effect of estrogen gradually decreases, so that, after the age of 50, the incidence of pathology in men and women becomes equal.
The following causes of arthrosis of the ankle joint 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 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, particularly 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 "erasing" of cartilage 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 an additional investigation program. It may consist of the following methods:
- Ultrasound scanning - the study allows you to assess the state of the soft tissue structures of the joint (cartilage, synovial bursa and surrounding tissues), this is the most informative method for early diagnosis of osteoarthritis changes;
- X-ray: this method mainly evaluates 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, which mainly affect the plate cartilaginous, it is extremely difficult).
In difficult clinical cases, CT or MRI can be used to detail the status of the ankle joint. Each of these methods allows you to obtain layer-by-layer scans (scanning step 2-3 mm) of the area under study and evaluate the state of the intra- and extra-articular structures of the ankle.
Expert opinion
Studies have shown that hormones actively participate in the growth and differentiation processes of cartilage 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 disrupt the balance between the process of cartilage formation and destruction, thereby causing 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 osteoarthritis 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 a stage of significant destruction of the cartilage plate and is accompanied by stiffness that interferes with human activity, endoprosthesis is indicated.
Conservative treatment
Conservative treatment of osteoarthritis begins with the creation of favorable conditions for the functioning of the joint. Recommended:
- Regular physical therapy exercises, swimming, and water aerobics are also helpful;
- normalization of body weight (if excessive);
- use of crutches or orthopedic canes during exacerbation of the process;
- wear comfortable orthopedic shoes.
To improve the condition of the cartilage plate, chondroprotectors are used, which are injected mainly into the joint. Therapy with hyaluronic acid and PRP (plasma therapy) restores the condition of the cartilage plate. To relieve pain, symptomatic treatment with non-steroidal anti-inflammatory drugs is carried out.
Surgery
Replacement of 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 uses only 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 talus, guaranteeing 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.
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 osteoarthritis.
Prevention of osteoarthritis of the ankle joint consists of following the following recommendations:
- wear comfortable, non-compressive footwear, use orthopedic insoles;
- perform feasible physical exercises;
- use of special anklets when playing professional sports;
- exclusion of jumping standing from a height;
- Timely correction of concomitant lower extremity deformities.
Rehabilitation
After the orthopedic intervention, temporary immobilization of the operated joint is performed. The period of immobility creates optimal conditions for the restoration of bone tissue and helps the implant integrate to the maximum. After removing the cast, gymnastics to improve health under the supervision of a physiotherapist, massage and physiotherapy are indicated.
Questions and answers
Which doctor treats ankle osteoarthritis?
Diagnosis and treatment of the disease is carried out by a traumatologist-orthopedist.
What is arthrodesis?
Arthrodesis is a surgical option that has been used previously for ankle osteoarthritis. 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 an ankle prosthesis?
After installing a third generation implant, a person can engage in "light" sports: skiing, swimming, cycling and light jogging. You should avoid high-impact sports: fast running, soccer, tennis, wrestling.