Arthrosis 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 primarily begins with damage to the cartilaginous base of the joint. Under the influence of unfavorable factors, the cartilage becomes thinner, fibers and cracks, which contributes to the exposure of the underlying bone. During movements in the joint, the exposed bone experiences a non-physiological load, so it tries to "protect itself". This provokes compensatory osteosclerosis (hardening) in the underlying subchondral zone, as well as the development of secondary subchondral cysts. In response, the ideal relationships of the articular surfaces are disrupted, which further aggravates the pathological process. As the disease progresses, the newly formed bone tissue forms growths (osteophytes) at the edges, which cause intense pain.
Deforming osteoarthritis of the ankle can be caused by various factors. These may be genetic, traumatic, growth and metabolic conditions. The initial destruction of 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 (crunching), the periodic appearance of effusion in the synovial cavity, as well as the secondary development of the inflammatory process. In addition to a clinical examination, ultrasound scanning of joints and radiography helps to establish the correct diagnosis. In complex cases, computed tomography or magnetic resonance imaging may be required.
Treatment of arthrosis 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 (and in particularly severe cases, steroidal) anti-inflammatory drugs help relieve pain. In case of severe destruction of the joint, endoprosthesis replacement is performed using third-generation prostheses, which are completely integrated with the bone.
Kinds
What does arthrosis 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, which is also called idiopathic, when it is not possible to establish 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 factors listed above.
In clinical medicine, there are 6 degrees of ankle arthrosis:
- 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 arthrosis it 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 disrupted, the location of chondrocytes in the deep zone changes;
- in the third degree, progression of the pathological process leads to the appearance of vertical cracks;
- at the fourth degree, the superficial zone of the cartilage peels off, eroded surfaces and cysts appear;
- fifth degree is characterized by exposure of the underlying bone;
- at the sixth degree, compensatory changes occur in the bone tissue, which consist in its compaction, the formation of osteophytes and microfractures.
Symptoms
The main manifestation of ankle arthrosis is pain. The distinctive characteristics of the 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, which leads to increased pain during physical activity and long walking;
- night aching pain caused by intraosseous stagnation of venous blood;
- blockade pain is a jamming in the ankle, in which a person can neither bend nor straighten the leg, becausepain increases significantly (the blockade occurs due to fragments of dead cartilage getting stuck between the articular surfaces);
- meteorological dependence - pain intensifies when the weather changes, when it gets colder and the humidity of the air increases.
Arthrosis of the ankle is a chronic process. Painful periods, which indicate an exacerbation of the disease, alternate with painless ones. As osteoarthritis progresses, the period between relapses shortens, and at a certain stage the pain may become permanent.
Causes of ankle arthrosis
On average, in people starting at the age of 30, a gradual destruction of the cartilage plate occurs, which outstrips 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 onset of the menopausal transition, the protective effect of estrogens gradually decreases, therefore, starting from the age of 50, the incidence of pathology in men and women equalizes.
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 poses 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, in particular those affecting the synthesis of type 2 collagen;
- ankle dysplasia;
- excess body weight, which increases the load on the ankle and contributes to the "erasure" of the 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.
Diagnostics
If you suspect osteoarthritis of the ankle joint, the doctor recommends an additional research program. It may consist of the following methods:
- Ultrasound scanning - 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-ray - this method primarily evaluates the structure of bone tissue, helps to identify subchondral osteosclerosis, the presence of cysts in the subchondral zone, and also visualize osteophytes (using X-ray to detect initial changes in osteoarthritis, affecting mainly the cartilaginous plate, is extremely difficult).
In difficult clinical cases, computed tomography or magnetic resonance imaging can be used to detail the condition 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 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. It has been established that chondrocytes have receptors for thyroid hormones, insulin, glucocorticosteroids, growth hormone, male and female sex steroids, as well as prolactin. Disorders of endocrine regulation are considered an important causative factor that can disrupt the balance between the process of formation and destruction of cartilage, thereby leading to dystrophy and degeneration. Therefore, it is so important to monitor the state of endocrine-metabolic reactions in the body, conduct 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 is indicated.
Conservative treatment
Conservative treatment of arthrosis begins with creating favorable conditions for the functioning of the joint. Recommended:
- regular physical therapy exercises, swimming and water aerobics are also useful;
- normalization of body weight (if it is excess);
- use of crutches or orthopedic canes during exacerbation of the process;
- wearing comfortable orthopedic shoes.
To improve the condition of the cartilage plate, chondroprotectors are used, which are injected mainly into the joint. 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
Ankle joint replacement is a rather complex task, so surgeons at 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 bone fragment. These prostheses stimulate osteoclasts (cells that form bone tissue), so they fuse well with the tibia, fibula and talus, which ensures 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, thereby evenly distributing the load on the joint.
Surgical intervention for ankle replacement 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 arthrosis of the ankle joint consists of following the following recommendations:
- wearing comfortable and non-compressive shoes, using orthopedic insoles;
- performing feasible physical exercises;
- use of special ankle braces when playing professional sports;
- exclusion of jumping on feet from a height;
- timely correction of concomitant deformities of the lower limb.
Rehabilitation
After orthopedic intervention, temporary immobilization of the operated joint is performed. The period of immobility allows you to create optimal conditions for the restoration of bone tissue and helps the implant to integrate most fully. After removing the plaster cast, health-improving gymnastics under the supervision of a physical therapy doctor, massage and physiotherapy are indicated.
Questions and answers
Which doctor treats ankle arthrosis?
The diagnosis and treatment of the disease is carried out by a traumatologist-orthopedist.
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 gait, but allows pain to be relieved. 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 "gentle" sports - skiing, swimming, cycling, and light jogging. You should avoid high-impact sports – fast running, football, tennis, wrestling.