Deforming osteoarthritis most commonly affects the joints of the lower extremities, one of which is the ankle. These joints have great mobility in different planes and perform an important function in walking (rolling the foot and transferring body weight from the heel to the toe) and also bear the weight of the human body. Osteoarthritis of the ankle is a kind of retaliation for walking upright. But many other factors also play a role in the development of the disease. First, the softening and thinning of the articular cartilaginous layer begins imperceptibly for the patient, then it ruptures, which provokes the inflammatory process, the growth of bone tissue in the form of osteophytes. With advanced osteoarthritis, a person cannot move unaided and experiences severe pain, especially when relying on the leg. Disability is possible within a few years of the onset of the disease if treatment is not started early and comprehensively.
Reasons for the development of the disease
Previous injuries to the ankle increase the likelihood that a degenerative process will develop in it.
- increased body weight;
- flat feet, congenital malformations of the feet (horse foot, clubfoot);
- Metabolic disorders in diseases such as diabetes mellitus, gout, arteriosclerosis of the leg vessels;
- Past joint injuries, e. g. B. damage to the ligaments, fractures of the ankles and foot bones;
- Constant overload of the joint, leading to microtrauma (in athletes and people who carry heavy loads);
- Hereditary predisposition to arthrosis of the joints;
- Previous joint inflammation (arthritis) of an infectious nature or in the case of systemic diseases (rheumatoid, psoriatic, gouty arthritis).
Depending on the absence or presence of a specific factor that caused the disease, osteoarthritis of the ankle can be primary or secondary. There is also a division into stages. In stage 1, a person is able to work when osteoarthritis has progressed to stages 2 and 3, pain and limited mobility result in disability (temporary or total).
Symptoms of osteoarthritis of the ankle
- "Starting" pain. This is one of the early symptoms of osteoarthritis of the ankle. Pain occurs after prolonged sitting, when trying to lean on the leg, and may be accompanied by short-term stiffness of movements in the joint. After a few steps, the pain disappears;
- pain during and after physical exertion;
- night pain, it is associated with an inflammatory process triggered by the destruction of cartilage tissue;
- crunch, clicks in joint during movement;
- swelling, especially noticeable under the ankles;
- restriction of movement;
- Hypotrophy of the periarticular muscles and weakness of the ligamentous apparatus due to the fact that a person begins to rest the sore leg;
- Joint deformity in the last stage of arthrosis.
diagnosis
Osteoarthritis and its exacerbation must be distinguished from various inflammatory processes in the joint, for example as a result of rheumatoid gout or psoriatic arthritis. Therefore, the doctor prescribes a detailed blood test, rheumatism tests, a test for CRP, uric acid. With arthrosis, these indicators are normal, but when the disease is in the acute stage, ESR and leukocytes may be increased. To determine the stage of arthrosis and get more detailed information about the pathology, x-rays in 2 projections, ultrasound, CT or MRI of the joint are used. A slight narrowing of the joint space can be seen on the x-ray in stage 1 arthrosis. During the transition to the 2nd stage, the joint gap is reduced by 40% or more compared to the norm. And in the 3rd stage it is significantly narrowed, it can be practically absent, growths and deformations of the bones are visible.
treatment methods
Arthrosis of the ankle, like other localizations, requires complex, long-term and long-term treatment.
- unloading the ankle during a period of severe exacerbation (walking with a cane on the side of a healthy limb), using a bandage;
- exclusion of shock loads (jumping, running), vibration, weight shifting, prolonged stay on the legs;
- body weight control;
- Stop smoking;
- Wearing a semi-rigid orthosis with simultaneous joint instability;
- physiotherapy (UHF, SMT, laser therapy, magnetic therapy);
- Medical therapy:
- NSAIDs external, oral, in injections;
- Glucocorticoids together with anesthetics intra-articularly and periarticularly to relieve inflammation;
- vascular agents;
- muscle relaxants to relieve muscle spasms;
- Chondroprotectors are more effective drugs that are administered intra-articularly. If it is not possible to obtain intra-articular injections, intramuscular administration, oral administration is indicated;
- Hyaluronic acid preparations to restore the quality of synovial fluid.
- Wear orthopedic insoles, comfortable shoes with small heels;
- Gymnastics to strengthen the musculoskeletal system. The following exercises should be performed daily:
- Lying down or sitting, bend and bend your toes 10 times;
- lying or sitting, pull your feet toward you and away from you 10 times;
- Rotate feet outward and inward 10 times;
- make clockwise and counterclockwise circular movements with your feet 10 times;
- Sit in a chair, place your feet on the floor with toes and heels together, alternate your legs forward and backward, and repeat 15-20 times.
- swimming, water aerobics;
- In the 3rd stage of arthrosis and ineffectiveness of conservative treatment, endoprosthetic replacement of the ankle or removal of the destroyed cartilage cover and joint capsule with its closure using a rod structure or the Ilizarov apparatus (arthrodesis) is indicated.
prevention
In order to reduce the risk of osteoarthritis, protein-rich foods should be preferred and spicy, salty, fried foods and alcohol should be excluded from the diet.
- Avoid joint injuries. To do this, you need to try not to wear shoes with unstable heels and too hard soles, and use special protective equipment when playing sports.
- control body weight;
- You need to stick to a diet, which means eating more high-protein foods and avoiding salty, spicy, fried alcohol.
- Timely treat and correct metabolic disorders, endocrine diseases, vascular diseases;
- Do the above exercises for the ankles.
The effectiveness of treatment of deforming arthrosis of the ankle depends on the stage of its development and the presence of concomitant diseases. In any case, if conservative therapy is indicated, it should include both drug and physical methods, as well as correction with orthopedic products.
Which doctor to contact
If you have ankle pain, you should see a rheumatologist. The doctor prescribes exercises, medication and identifies the cause of the disease. With diabetes or gout, it makes sense to visit an endocrinologist, with atherosclerosis of the vessels of the lower extremities - a vascular surgeon and a cardiologist. An important role in the treatment is played by an orthopedic surgeon – he will not only help you choose the right shoes, orthopedic insoles, but also, if necessary, perform an operation. If you are overweight, you need to consult a nutritionist and choose the right diet. Non-drug treatment is carried out with the participation of a physiotherapist.