Arthrosis of the ankle joint is a degenerative-dystrophic change of the cartilaginous plate of the joint and the underlying bone.
About the disease, the aggravation and progression of the process
The disease primarily begins with damage to the cartilage base of the joint. As a result of unfavorable factors, the cartilage thins, becomes fibrous and cracks, which contributes to the exposure of the underlying bone. During movements in the joint, the exposed bone suffers a non-physiological load, so it tries to "protect itself". This causes compensatory osteosclerosis (hardening) in the underlying subchondral zone, as well as the formation of secondary subchondral cysts. In response, the ideal connections of the articular surfaces are broken, which furtheraggravates the pathological process As the disease progresses, the newly formed bone tissue forms growths (osteophytes) on the edges, which cause intense pain.
Deforming osteoarthritis of the ankle can be caused by various factors. These can be genetic, traumatic, growth and metabolic conditions. The initial destruction of the articular cartilage gradually leads to damage to all the tissues of the articular joints.
The main clinical signs of osteoarthritis are pain and limited movement of the ankle. The disease is also characterized by the symptom of crepitus, the periodic appearance of effusion in the joint cavity, and the secondary development of the inflammatory process. In addition to the clinical examination, ultrasound examination of the joints and radiography help to establish the correct diagnosis. In complicated cases, computed tomography or magnetic resonance imaging may be necessary.
Treatment of arthrosis of the ankle joint is usually carried out with conservative methods. To improve the functional state of the cartilage plate, chondroprotectors are prescribed, incl. by intra-articular administration method. Nonsteroidal (and in particularly severe cases, steroidal) anti-inflammatory drugs help relieve pain. In case of severe destruction of the joint, the endoprosthesis is replaced with third-generation prostheses that are completely integrated into the bone.
Types
What does arthrosis of the ankle joint mean, taking into account the developmental mechanisms? According to the classification, the disease has 2 versions:
- primary osteoarthritis, which is also called idiopathic, when the true cause of the disease cannot be established even with the most modern examination;
- secondary arthrosis, which is caused by the action of the clearly defined trigger factor or factors listed above.
In clinical medicine, ankle arthrosis has 6 degrees:
- in the first degree, the surface zone of the cartilage is not damaged, but the matrix swells and disintegrates, the chondrocytes multiply, and the type of collagen they synthesize changes (usually the cartilage plate is made up of the second type of collagen, and in arthrosis it is replaced by the less durable third type of collagen);
- in the second degree, the integrity of the surface zone of the cartilaginous plate is broken, the location of the 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 surface zone of the cartilage peels off, eroded surfaces and cysts appear;
- the fifth degree is characterized by exposure of the underlying bone;
- in the sixth degree, compensatory changes occur in the bone tissue, which consist of compaction, the formation of osteophytes and microfractures.
Symptoms
The main manifestation of ankle arthrosis is pain. Distinctive features of pain syndrome in this disease:
- the initial nature of the pain, when it is most pronounced at the beginning of the movement;
- mechanical in nature, which leads to increased pain during physical activity and long walking;
- aching pain at night caused by intraosseous stagnation of venous blood;
- Blockage pain is ankle entrapment, in which a person cannot bend or straighten the leg, because the pain increases significantly (the blockade occurs due to the entrapment of pieces of dead cartilage between the joint surfaces);
- meteorological dependence - the pain intensifies when the weather changes, when it becomes colder and the air humidity increases.
Ankle arthrosis is a chronic process. Painful periods, which indicate the worsening of the disease, alternate with painless ones. As osteoarthritis progresses, the period between relapses shortens, and at a certain stage the pain can become permanent.
Causes of ankle arthrosis
On average, starting from the age of 30, the gradual destruction of the cartilage plate occurs, which exceeds the rate of new cartilage formation. Therefore, the frequency 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 occurrence of the pathology in men and women equalizes.
The following causes of arthrosis of the ankle joint are identified, which lead to the fact that the resynthesis of cartilage tissue does not have time to cover the catabolism (destruction) of cartilage:
- suffered traumatic injuries (jumping from a height is a particular danger);
- previous inflammatory changes of the joint;
- ankle deformities, which can be associated with flat feet, varus or valgus position of the foot;
- hereditary collagenopathies, especially those affecting the synthesis of type 2 collagen;
- ankle dysplasia;
- excess weight, which increases the load on the ankle and contributes to the "erasure" of cartilage layers;
- postmenopausal period (the average age of permanent cessation of menstruation in women is 50-52 years);
- metabolic disorders;
- sedentary lifestyle;
- previous orthopedic interventions on the joint;
- repeated hypothermia.
Diagnostics
If arthrosis of the ankle joint is suspected, the doctor recommends an additional research program. It can consist of the following methods:
- Ultrasound scanning - the study allows assessing the condition of the soft tissue structures of the joint (cartilage, synovial bursa and surrounding tissues), this is the most informative method for 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, as well as the visualization of osteophytes (with the help of X-ray, the initial changes of osteoarthritis, which mainly affect the cartilage plate, are extremely difficult).
In difficult clinical cases, computed tomography or magnetic resonance imaging can be used to detail the condition of the ankle joint. All of these methods allow layer-by-layer scanning of the examined area (2-3 mm scanning step) and assessment of the condition of the intra- and extra-articular structures of the ankle.
Expert opinion
Studies have shown that hormones are actively involved in the growth and differentiation processes of cartilage tissue. Chondrocytes have been found to have receptors for thyroid hormones, insulin, glucocorticosteroids, growth hormone, male and female sex steroids, and prolactin. Endocrine dysregulation is considered to be an important cause that can disrupt the balance between the process of cartilage formation and destruction, thereby leading to dystrophy and degeneration. Therefore, it is very important to monitor the state of the body's endocrine-metabolic reactions, perform screening tests to assess the functional state of the thyroid gland, and consult an endocrinologist at the first suspicious symptoms.
Treatment of ankle arthrosis
At the initial stage, arthrosis is treated with conservative methods. Timely treatment can protect the joint from destruction and delay or completely avoid the need for surgery. If the disease is detected in the stage of significant destruction of the cartilage plate and is accompanied by stiffness that interferes with human activity, endoprosthesis is recommended.
Conservative treatment
Conservative treatment of arthrosis begins with the creation of favorable conditions necessary for the functioning of the joint. Recommended:
- regular physical therapy exercises, swimming and water aerobics are also useful;
- normalization of body weight (if overweight);
- use of crutches or orthopedic sticks during exacerbation of the process;
- in comfortable orthopedic shoes.
To improve the condition of the cartilage plate, chondroprotectors are used, which are mainly injected into the joint. Hyaluronic acid and PRP therapy (plasma therapy) restore the condition of the cartilage plate. Symptomatic treatment with non-steroidal anti-inflammatory drugs is used to relieve pain.
Surgery
Replacing the ankle joint is a rather complex task, therefore the surgeons of the modern medical center strictly adhere to the modern surgical methodology, which allows them to achieve the best therapeutic results. Currently, this operation only uses third-generation implants, which only require the removal of a small piece of bone. These prostheses stimulate osteoclasts (cells that make up bone tissue) so they fuse well with the tibia, fibula and talus, which provides special structural strength. The unique feature of the third-generation prosthesis is that it enables not only the main joint, but also the articulation between the fibula and the tibia, thus evenly distributing the load on the joint.
The surgical intervention of the ankle prosthesis includes the correction of the existing deformities and the suturing of the damaged ligaments. This creates favorable conditions for maintaining the stability of the joint and fully ensuring its functions.
Prevention of arthrosis of the ankle
Prevention of arthrosis of the ankle joint consists in following the following recommendations:
- wearing comfortable and non-pressing shoes, using orthopedic insoles;
- carrying out feasible physical exercises;
- use of special ankle braces during professional sports;
- the exclusion of jumping from a height;
- timely correction of simultaneous deformations of the lower limb.
Rehabilitation
After orthopedic intervention, the operated joint is temporarily immobilized. The period of immobility allows you to create optimal conditions for the restoration of bone tissue and helps the most complete integration of the implant. After removing the cast, physical therapy, physical therapy, massage, physical therapy are recommended.
Questions and answers
Which doctor treats ankle arthrosis?
The disease is diagnosed and treated by a traumatologist-orthopedic.
What is arthrodesis?
Arthrodesis is a surgical option that was previously used for ankle arthrosis. The operation involves immobilization of the joint, which negatively affects walking, but allows for pain relief. Therefore, endoprosthesis replacement is considered a more optimal and physiological option in the surgical treatment of ankle osteoarthritis.
Can I do sports after ankle replacement?
After insertion of the third-generation implant, the person can engage in "gentle" sports - skiing, swimming, cycling and light jogging. Avoid high-impact sports - sprinting, football, tennis, wrestling.