Ankle arthritis is a degenerative-dystrophic lesion of the cartilage plate of the joint and the underlying bone.
About the disease, exacerbations and progression of the process
The disease mainly begins with damage to the cartilage base of the joint. Under the influence of unfavorable factors, the cartilage becomes thinner, fibrous and cracked, contributing to exposing the underlying bone. During movement at the joint, the exposed bone is subjected to a non-physiological load, so it tries to "protect itself". This causes compensatory bone sclerosis (hardening) in the primary subchondral area, 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, newly formed bone tissue grows (osteophytes) at the edges, causing severe pain.
Ankle osteoarthritis deformity can be caused by many different factors. These can be genetic, traumatic, growth and metabolic conditions. The initial destruction of articular cartilage gradually leads to damage to all tissues of the synovial joint.
The main clinical signs of osteoarthritis are pain and limited mobility in the ankle. The disease is also characterized by the symptom of crepitus (crepitus), the periodic appearance of effusion in the synovial cavity, as well as the secondary development of the inflammatory process. In addition to clinical examination, joint ultrasound and X-rays help determine the correct diagnosis. In complicated cases, computed tomography or magnetic resonance imaging may be needed.
Treatment of ankle arthritis is usually performed using conservative methods. To improve the functional state of the cartilage plate, chondroprotective agents are prescribed, incl. with intra-articular administration. Nonsteroidal anti-inflammatory drugs (and in especially severe cases, steroids) help relieve pain. In cases of severe joint destruction, arthroscopic replacement is performed using a third generation prosthesis, fully integrated with the bone.
Types
What does ankle arthritis mean when considering the mechanism of development? According to classification, the disease has 2 variants:
- primary osteoarthritis, also called idiopathic, when the true cause of the disease cannot be determined even with the most modern examination;
- secondary arthritis, caused by the influence of one or more of the pathogenic factors clearly identified above.
In clinical medicine, there are 6 levels of ankle osteoarthritis:
- In the first degree, the surface area of the cartilage is not damaged, but there is swelling and breakdown of the matrix, chondrocytes proliferate and the type of collagen they synthesize changes (normally, a cartilage sheet is formedby collagen of the second type). , and in arthritis it is replaced by less durable collagen of the third type);
- at the second level, the integrity of the surface zone of the cartilage plate is broken, the location of chondrocytes in the deep zone changes;
- at the third degree, the progression of the pathological process leads to the appearance of longitudinal cracks;
- In the fourth degree, the surface area of the cartilage peels off, the surface is eroded and a cyst appears;
- The fifth degree is characterized by exposure of the underlying bone;
- At the sixth degree, compensatory changes occur in bone tissue, including its compaction, the formation of bone spurs and microcracks.
Symptom
The main symptom of ankle arthritis is pain. The special features of the pain syndrome in this disease are:
- the initial nature of the pain, when it is most pronounced at the beginning of movement;
- has a mechanical nature, leading to greater pain during physical activity and long walks;
- pain at night due to venous blood stagnation;
- Blockade pain is a condition of ankle entrapment, in which a person is unable to bend or straighten the leg, because the pain is significantly increased (blockade occurs due to pieces of dead cartilage getting stuck between the surfaces). joint);
- depends on meteorology - pain increases when the weather changes, when it gets colder and air humidity increases.
Ankle arthritis is a chronic process. Painful periods, representing the severity of the disease, alternate with painless periods. As osteoarthritis progresses, the time between relapses shortens and at a certain stage, the pain can become permanent.
Causes of ankle arthritis
On average, in people starting at age 30, the gradual destruction of cartilage occurs faster than the rate at which new cartilage is formed. Therefore, the incidence of the disease increases with age. There are also certain sexual characteristics. Therefore, before menopause, women's joints are protected from destruction. With the onset of menopause, the protective effect of estrogen gradually decreases, therefore, starting from age 50, the incidence of pathology in men and women is equal.
The following causes of ankle osteoarthritis are identified, which lead to the resynthesis of cartilage tissue not having time to compensate for the catabolism (destruction) of cartilage:
- being injured (jumping from a height poses a particular danger);
- previous inflammatory lesions of the joint;
- ankle deformity, which may be related to flat feet, varus or varus position of the foot;
- hereditary collagen diseases, especially those affecting type 2 collagen synthesis;
- Ankle dysplasia;
- excess body weight, which increases the load on the ankle and contributes to the "erasure" of cartilage layers;
- postmenopausal period (the average age of cessation of prolonged menstruation in women is 50-52 years old);
- metabolic disorder;
- sedentary lifestyle;
- previous orthopedic intervention on the joint;
- repeated hypothermia.
Diagnose
If you suspect ankle osteoarthritis, your doctor will recommend a program of additional studies. It may include the following methods:
- Ultrasound scan - the study allows you to evaluate the condition of the soft tissue structures of the joint (cartilage, synovium and surrounding tissues), this is the most useful method for early diagnosis of joint changes;
- X-ray - this method mainly evaluates the structure of bone tissue, helps to determine subchondral bone sclerosis, the presence of cysts in the subchondral area, and also helps to visualize bone spurs (useX-rays to detect early changes in osteoarthritis, which primarily affect the cartilage plate, are extremely difficult).
In difficult clinical cases, computed tomography or magnetic resonance imaging can be used to know in detail the condition of the ankle joint. Each of these methods allows you to scan layer by layer (scanning steps of 2-3 mm) of the area under study and evaluate the condition of the intra- and extra-articular structures of the ankle.
Expert opinion
Studies have shown that hormones play an active role in the growth and differentiation of cartilage tissue. It has been established that chondrocytes have receptors for thyroid hormones, insulin, glucocorticosteroids, growth hormones, male and female sex steroids, as well as prolactin. Endocrine dysregulation is considered an important causative factor that can disrupt the balance between cartilage formation and destruction, thereby leading to dystrophy and degeneration. Therefore, it is important to monitor the state of endocrine metabolic reactions in the body, conduct screening tests to assess the functional state of the thyroid gland, and contact an endocrinologist when there are these symptoms. first suspicious symptom.
Treatment of ankle arthritis
Treatment of joint disease in the early stages is carried out using conservative methods. Prompt treatment can protect the joint from destruction and delay or completely avoid the need for surgical intervention. If the disease is detected at a stage where cartilage is significantly destroyed and is accompanied by joint stiffness that hinders human activity, endoscopy is indicated.
Conservative treatment
Conservative treatment of arthritis begins with creating favorable conditions for joint function. Encourage:
- Regular physical therapy exercises, swimming and water aerobics are also helpful;
- normalizes body weight (if excess);
- use crutches or orthopedic canes during exacerbation;
- Wear comfortable orthopedic shoes.
To improve the condition of the cartilage plate, chondroprotectants are used, which are injected mainly into the joints. Hyaluronic acid and PRP therapy (plasma therapy) restore the condition of the cartilage plate. To relieve pain, symptomatic treatment is carried out with nonsteroidal anti-inflammatory drugs.
Surgery
Ankle joint replacement is quite a complicated job, so surgeons at the modern medical center strictly follow modern surgical methods, helping to achieve the best treatment results. Currently, this surgery uses only third-generation implants, which only require the removal of a small piece of bone. These prostheses stimulate osteoclasts (cells that form bone tissue), so they fuse well with the tibia, fibula and talus, ensuring exceptional structural strength. A unique feature of the third generation prosthesis is that it allows movement of not only the main joint but also the joint between the fibula and the tibia, thereby distributing the load evenly across the joint.
Surgical intervention for ankle replacement also involves correcting existing deformities and suturing damaged ligaments. This facilitates the maintenance of joint stability and ensures full joint function.
Preventing ankle arthritis
Prevention of ankle arthritis includes the following recommendations:
- wear comfortable and non-compression shoes, use orthopedic insoles;
- perform feasible physical exercises;
- use special ankle braces when playing professional sports;
- exclude jumping with your feet from a height;
- Timely correction of concomitant deformities of the lower extremities.
Rehabilitation
After orthopedic intervention, temporary fixation of the surgical joint is performed. The period of immobilization allows you to create optimal conditions for bone tissue recovery and helps the implant integrate most completely. After the cast is removed, perform health-promoting exercises under the supervision of a physical therapist, massage therapist, and physical therapist.
Questions and answers
Which doctors treat ankle arthritis?
Diagnosis and treatment of the disease are performed by an orthopedic traumatologist.
What is "arthrodesis"?
Osteoarthritis is a surgical procedure that has previously been used for ankle arthritis. This operation involves immobilizing the joint, which negatively affects gait, but helps relieve pain. Therefore, arthroscopic replacement is considered a more optimal and physiological option in the surgical treatment of ankle osteoarthritis.
Can I play sports after ankle replacement?
After installing the third generation implant, a person can engage in "light" sports - skiing, swimming, cycling and light jogging. You should avoid high-impact sports - fast running, football, tennis, wrestling.