Ankle osteoarthritis

In recent years, experts around the world have noticed an increase in degenerative-dystrophic processes in the joint, which gradually leads to disability. Ankle osteoarthritis often develops as a result of serious injuries or permanent microtrauma in athletes, professional dancers, circus performers. How to spot the signs of this disease in time and stop its progression, as well as how to treat it, you will learn from this article.

Ankle osteoarthritis - what is it

The ankle is a complex joint-like block formed by the lower (distal) ends of the tibia and fibula of the lower leg, forming the inner and outer ankles (ankle), as well as the talus of the foot. It is strengthened on the inside by the deltoid ligament, on the outside by the anterior and posterior talofibular and calcaneofibular ligaments. Function: flexion and extension of the foot. The ankle is functionally connected to the foot, it has common ligaments and muscle tendons with the ankles.

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

The disease is less common than a similar knee lesion and is usually the result of serious injury or long-term injury as a result of any activity.

Causes of ankle osteoarthritis

Specialists studied in detail the reasons for the development of ankle arthrosis and arthrosis of the foot. This:

• injuries - intra-articular fractures of the joints, fractures of the ankles, complete and incomplete rupture of ligaments and tendons;
• microtrauma due to any professional activity - these are ballerinas, dancers, professional athletes;
• increased load on overweight legs;
• improper load distribution when wearing high-heeled shoes;
• metabolic disorders that negatively affect the metabolism in cartilage tissue - diabetes mellitus, obesity, gout, etc. ;
• hormonal changes, including age-related changes;
• transmitted severe acute purulent arthritis;
• long-term chronic arthritis of any origin;
• osteochondrosis of the lumbar spine and intervertebral hernia, which causes damage to the spinal roots and weakening of the muscles of the lower leg and foot, leading to instability and joint injuries.

Mechanism of disease development (pathogenesis)

Under the influence of various reasons, there is a disturbance of blood circulation in the joint region, which leads to a decrease in the volume of synovial fluid that feeds the cartilage tissue. Due to the lack of oxygen and nutrients, the cartilage becomes thinner, cracks and erosions appear on it. This leads to injury to the subcartilaginous layer of the bone. Thickens (sclerosis) and grows along the edges of joint surfaces. These growths are called osteophytes. They compress the soft tissues, blood vessels and nerves, causing pain and further obstructing blood circulation.

Due to circulatory disorders and high tension, muscles suffer, they are weakened, which leads to joint instability and frequent sprains. Osteoarthritis of the feet develops, small tarsal joints, metatarsal-tarsal, metatarsophalangeal and interphalangeal joints are affected.

Gradually, the connective tissue grows in the joints, firmly binding the joint surfaces and impairing joint function. Complete loss of ankle function is associated with fusion of the articular bones. Osteoarthritis of the feet also developed gradually.

Symptoms of ankle osteoarthritis

Osteoarthritis of the ankle initially occurs slowly and imperceptibly. But the symptoms gradually appear and increase, signaling some kind of injury in the lower extremity.

The first signs

The first symptom of ankle osteoarthritis is pain under heavy loads, for example, during long walks, dancing, playing football or volleyball, etc. This pain passes quickly, so the person does not pay attention to it immediately, he attributes it to muscle fatigue. The pain can be both symmetrical in both joints (with heavy load and microtrauma) and unilateral (after a major injury).

Then there is a feeling of numbness in the morning or after a long stay in a stationary state. The ankles stiffen for a while, making it difficult to move. In the initial stages it lasts a few minutes and passes after a slow pace. This symptom should already warn and become a reason to go to the doctor.

Open symptoms

Gradually, the pain after exertion intensifies and lasts longer. The leg can hurt all day. Nocturnal pains combine, usually occurring in the second half of the night, and are sometimes accompanied by painful muscle cramps. Periods of stiffness after immobility are also prolonged.

Due to the severe pain, the person begins to limp while walking, trying to reduce the pain in the foot by stretching or pressing. Sometimes the ankle swells, the skin over it turns red, the pain intensifies. This is a sign of synovitis - inflammation of the inner synovial membrane. Inflammation is non-infectious in nature, develops by mechanical irritation and goes away on its own without treatment. But at the same time, the worsening of synovitis activates the progression of the joint degenerative-dystrophic process.

Dangerous symptoms

Constant aching pain, intensified by physical exertion, instability, loose joints, prone to subluxations, dislocations and ligament injuries are dangerous symptoms that require a visit to the doctor. The ankle changes externally: it takes on a different shape due to overgrown osteophytes. Osteoarthritis of the ankle (ankle joint) leads to its thickening. The movements in the foot are a little limited at the beginning, and then the ankle joint becomes immobile or, conversely, loose, unstable. But even at this stage, the patient can be helped, you just need to contact the clinic. Symptoms of arthrosis of the foot appear: pain in the foot, violation of its flexion and depreciation. The development of osteoarthritis of the big toe is accompanied by pain and deformity of the foot in the form of bulging and bending of the big toe outwards.

What is dangerous arthrosis of the ankle

The danger is that the disease initially develops imperceptibly and very often the patient goes to the doctor, but at an advanced stage.

Every localization and form of arthrosis has serious complications, so treatment should not be delayed.

Classification

Osteoarthritis of the ankle can be primary, when the cause of its development has not been determined, and secondary, with a known cause. Depending on the cause of development, the disease may have its own special characteristics.

Posttraumatic ankle osteoarthritis

The consequences of traumatic injuries are the most common cause of the disease. Post-traumatic osteoarthritis of the ankle can develop after a major injury - ligament rupture, dislocation, intra-articular fracture. Usually one joint is injured, so post-traumatic osteoarthritis is one-sided. A small but untreated injury may not be felt at first. And only after some time, when the person has already forgotten about it, a slight growing pain appears. This type of injury is dangerous because the patient goes to the doctor in a neglected state. Serious injuries are better treated, their consequences occur faster and the patient does not seek medical help so late.

The inconspicuous long-term microtrauma of both ankles is typical for professional dancers, athletes and people whose profession is associated with a long stay on their feet. Symmetrical pain in the ankle joints occurs during physical exertion. They are usually mistaken for muscle pain with fatigue, so it is too late to see a doctor.

Ankle osteoarthritis after arthritis

The causes of these arthrosis can be chronic inflammatory processes in the joints (arthritis): rheumatoid, reactive, psoriatic. In this case, inflammatory processes are combined with degenerative-dystrophic (arthritis-arthritis). This speeds up the process of destroying the ankle joint. With the worsening of the inflammation, the joints swell, the skin over them becomes red, the pain becomes very strong, especially at night. When the inflammation subsides, metabolic disorders dominate, and all processes develop very quickly. The disease requires constant monitoring and treatment by a rheumatologist.

Much less often, the degenerative-dystrophic process develops after acute purulent arthritis. The purulent process destroys the joint tissues and after recovery, connective tissue is formed in their place, which impairs the function of the extremities.

Osteoarthritis can also form after infectious arthritis - tuberculosis, gonorrhea, etc. Disease progression is related to the main infectious process and the nature of the destruction. If the infection persists, the destruction of the joints will progress.

Metabolic

It develops with a long course of gout. Very often the first toe is affected. Other small ankles and ankles are less commonly affected. As gout attacks continue, it is difficult to determine externally when the degenerative-dystrophic process occurs. You can only see this on an X-ray. In any case, the patient should be monitored regularly by a rheumatologist and examined periodically.

Deforming arthrosis of the ankle

All types of osteoarthritis deform over time. Bone deformities indicate an advanced stage of the disease, when the cartilage has already collapsed, and the constant mechanical impact on the bone tissue contributes to its growth along the edges of the joint surface. This is how osteophytes are formed that change the shape of the joint.

Degrees of ankle osteoarthritis

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

1. Early. Slight pain after standing or walking for a long time, some numbness in the morning. All this quickly disappears without any help. X-ray: normal or slight narrowing of the joint space.
2. progressive. The pain after physical exertion is stronger and longer. Stiffness increases, there is a squeak in the joints during movement. Sometimes the joint swells, reddens and hurts a lot - it is a sign of synovitis. X-rays show significant narrowing of the joint space, thickening of the subcartilaginous bone tissue (osteosclerosis) and proliferation of osteophytes.
3. Final. The pain syndrome intensifies, it becomes permanent. Due to the pain, the person limps, underlines his feet, uses a stick or crutches. Limb function is impaired, arthrosis of the feet and toes develops. Complete absence of flexion-extensor movements is rare, usually in the background of arthrosis-arthritis. On the X-ray: no joint space, osteosclerosis, large osteophytes that deform the joint.

Possible complications

If the disease is not treated and everything goes its course, the following complications are possible:

• permanent joint dysfunction and disability;
• severe constant pain in the ankle and feet, both after exertion and without it;
• ankle instability with the development of common dislocations and subluxations;
• damage to the feet and toes will merge, which will further aggravate the patient’s condition.

Diagnosis of ankle osteoarthritis

Prior to prescribing treatment, the physician conducts an examination of the patient, including:

• medical interview and examination;
• additional research methods: laboratory tests (detecting signs of inflammation and metabolic disorders), instrumental studies (radiography of the joint in two projections, computer and magnetic resonance imaging - detecting early changes in bone structures and soft tissues), diagnostic arthroscopy (examining the inner joint surface).

Treatment of ankle osteoarthritis

After making the final diagnosis, the doctor selects an individual treatment complex for the patient, which consists of medical and non-medical methods.

Medical treatment of osteoarthritis of the ankle

Drugs that have symptomatic (eliminate the symptoms of the disease) and pathogenetic (suppress the mechanism of disease development) action are prescribed.

Anti-inflammatory and pain medications

To eliminate pain, drugs from the group of non-steroidal anti-inflammatory drugs (NSAIDs) are prescribed in short courses, they alleviate pain and inflammation (if synovitis has worsened):

• injection;
• rectal suppositories;
• oral tablets;
• skin patch.

Muscle relaxants

The muscles that surround the diseased joint and perform its movement are in constant tension, which leads to their atrophy and increased pain. Drugs from the group of muscle relaxants are prescribed to eliminate muscle cramps.

Chondroprotectors

Chondroprotective drugs contain glucosamine or chondroitin, and sometimes both. They protect cartilage cells from destruction and encourage their regeneration. They are prescribed in the form of injections, tablets and external means (creams and ointments).

Hyaluronic acid preparations for ankle osteoarthritis

To improve the amortization capacity of synovial fluid and prevent further injury to cartilage and bone tissue, hyaluronic acid is injected into the joint cavity. This results in pain relief and improved joint mobility.

Antiarthritis gels and ointments for ankle osteoarthritis

External funds can be used at home. Osteoarthritis ointments:

• NSAID gels are suitable for relieving pain and inflammation;
• for cartilage regeneration - chondroitin-based gel and ointment.

Drug-free therapy

The main methods of treating ankle osteoarthritis are not drugs. These are therapeutic exercises, massage, physiotherapy, wearing orthopedic aids.

Physiotherapy

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

• electrophoresis with medicinal substances;
• laser therapy;
• magnetotherapy;
• heating procedures - paraffin, ozokerite, in resort conditions - mud applications.

Massage for ankle osteoarthritis

Massage courses improve blood circulation, which leads to the activation of metabolism, renewal of joint and extra-articular tissues. The positive effect of massage on the muscles is the elimination of cramps, which contributes to the flow of blood to the muscles, and restoring their strength needed to keep the limb in the desired position.

Exercises and exercise therapy for ankle osteoarthritis

Therapeutic gymnastics is a cure for osteoarthritis. Motor activity is very important, in addition to exercise therapy, swimming is useful. Systematic performance of exercises chosen by the doctor allows you to greatly restore the function of the limbs, even with advanced disease.

Approximate set of exercises (but before you start using it, you should consult your doctor):

Use of special orthopedic products

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

Fixation of the ankle joint can also be done with the help of taping: the adhesive joint is gently fixed in the desired position with special adhesive tapes.

Surgical intervention

Surgery is recommended for severe pain that cannot be relieved by conservative treatment methods, as well as for significant limb dysfunction.

Types of surgical interventions

Operations can be performed in traditional and gentle ways:

1. Therapeutic arthroscopy (sparing operations):
   • repair of the joint cavity - with the help of an arthroscope, fragments of cartilage and bone tissue are removed from the cavity, which interfere with movement and cause pain;
   • chondroplasty - removes the damaged layer of cartilage, which stimulates the growth of new cartilage cells (abrasive chondroplasty); in some cases, transplantation of cartilage parts taken from unloaded areas of the patient's knee joint (mosaic arthroplasty) is performed; chondroplasty is effective in stage 2 disease, when the joint has not yet lost its function.
2. Arthrodesis is a traditional surgical operation. It is performed with significant violation of limb function, its looseness, common dislocations and pain. The ankle is removed, the lower leg bones fused with the foot bones. The ankle becomes immobile and serves only as a support.
3. Endoprosthetics are the replacement of worn and lost ankle function with an artificial one.

Post-surgery rehabilitation features

All operations are performed in inpatient conditions, after which experts recommend complete rehabilitation. In addition to sparing operations, rehabilitation is carried out on an outpatient basis with early involvement in therapeutic exercises with the exception of heavy loads on the joint. After the endoprosthesis, the patient stays in the hospital for a week, and then outpatient rehabilitation measures are carried out. After two weeks, the sutures are removed and the patient can take a shower.

Dietary food

There is no special diet for osteoarthritis. But in order to eliminate unnecessary stress on the ankle, it is necessary to maintain a normal body weight. The person should get a proper healthy diet, but the amount of high-calorie food should be partially replaced by vegetables and fruits. Useful first and second low-fat dishes, chicken, sea fish, cottage cheese, cheese, dairy products.

Traditional medicine

Just using traditional medicine for osteoarthritis will not help. But they can be used as part of a complex treatment prescribed by a doctor. Here are some recipes:

• for oral use: infusion of wild rosemary; Pour 20 g of finely chopped grass overnight in a thermos with 500 ml of boiling water, strain in the morning and take half a cup 4 times a day for a month; analgesic, cartilage tissue repair;
• for oral use: take a ball of mummy with a diameter of 0. 5 cm in the morning, chew well, 30 minutes before meals for 10 days; break for 5 days, then repeat everything 3 more times; excellent stimulator of metabolic processes;
• honey massage: apply warm liquid honey on the ankle before bed and gently rub massaging the tissues for 5 minutes; then wrap your leg in a warm scarf and leave until morning; restores blood circulation and metabolism in cartilage tissue.

Approach to treatment in clinics

Clinic physicians have developed their own approach to treating diseases such as ankle and foot osteoarthritis. At the first examination, a thorough examination of the patient is performed, the doctor listens carefully to his complaints and medical history, after which he prescribes additional laboratory and instrumental studies, including MRI. Only after that, the doctor makes the final diagnosis, prescribes and agrees with the patient on a complex treatment. It consists of:

• modern schemes of arthrosis treatment with drugs and non-drugs - drugs, physiotherapy, exercise therapy and massage, ankle fixation methods;
• traditional methods of oriental therapy - acupuncture, moxibustion, acupressure, various methods of kinesitherapy, including taping.

These are not all methods used in clinics. Physicians are able to combine western and eastern methods, significantly accelerating the improvement of the patient's condition. Patients quickly get rid of pain, their quality of life improves significantly.

A combination of proven techniques of the East and innovative methods of Western medicine.

Prevention of osteoarthritis of the feet

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

• activity, exercise therapy 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 legs are injured during work, then it is worth changing it;
• injuries, especially in winter on ice, should be ruled out by thinking about the way you move and the shoes you use;
• a rational diet is necessary to restore metabolism, but being overweight is an additional burden on the ankle, get rid of it;
• preventive treatments are a guarantee of a pain-free life.

Frequently asked questions about the disease

1. Which doctor should I consult for osteoarthritis of the ankle and arthrosis of the foot?

   Orthopedist traumatologist. But if the disease developed in the background of some kind of rheumatic process, then at the 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 it at the beginning of the disease, not to wait for complications to appear.

3. Can osteoarthritis of the ankle develop in children?

   Maybe after an injury or on the background of congenital pathology.

4. What are the consequences of the disease?

   Untreated osteoarthritis leads to disability. If you start treatment on time, it is quite possible to preserve limb function. Treatment in the later stages will alleviate the pain and improve the quality of life.

5. Are sports injuries the cause of osteoarthritis of the ankle?

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

6. Is It Possible To Do Ankle Taping In Osteoarthritis?

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

Ankle osteoarthritis is almost always the result of macro- or microtrauma. At first it takes place slowly and imperceptibly. Therefore, timely treatment and rehabilitation after injuries is important, as well as reporting to a doctor at the first signs of ankle disease.