Ankle arthrosis is a degenerative-dystrophic lesion of the cartilage plate of the joint and the bone below it.
About the disease, exacerbation and progression of the process
The disease primarily begins with damage to the cartilage base of the joint. Under the influence of unfavorable factors, the cartilage becomes thinner, fibrous and cracks, which contributes to the exposure of the underlying bone. During movement in the joint, the exposed bone experiences an unphysiological load, so it tries to "protect" itself. This causes compensatory osteosclerosis (hardening) in the subchondral zone, as well as the development of secondary subchondral cysts. In response, the ideal relations of the articular surfaces are disturbed, which further aggravates the pathological process. As the disease progresses, the newly formed bone tissue forms growths (osteophytes) at the edges that cause intense pain.
Deforming osteoarthritis of the ankle joint 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 tissues of the synovial joints.
The main clinical signs of osteoarthritis are pain and limited mobility of the ankle joint. 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. Along with the clinical examination, ultrasound scanning of the joints and radiography help 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 by conservative methods. To improve the functional state of the cartilage, chondroprotectors are prescribed, incl. with intra-articular route of administration. Nonsteroidal (and in particularly severe cases, steroidal) anti-inflammatory drugs help relieve pain. In case of severe destruction of the joint, the replacement of the endoprosthesis is performed with third-generation prostheses, which are completely integrated with the bone.
Species
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 determine 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 stage, the surface area of the cartilage is not damaged, but there is swelling and disintegration of the matrix, chondrocytes proliferate and the type of collagen it synthesizes changes (normally, the cartilage plate is formed by collagen of the second type, and in arthrosis it is replaced by the less durable collagen of the third type);
- in the second stage, the integrity of the surface zone of the cartilage plate is violated, the location of chondrocytes in the deep zone changes;
- in the third stage, the progression of the pathological process leads to the appearance of vertical cracks;
- at the fourth stage, the surface zone of the cartilage peels off, eroded surfaces and cysts appear;
- the fifth degree is characterized by exposure of the lower bone;
- in the sixth stage, there are compensatory changes in the bone tissue, which consist in its compaction, formation of osteophytes and microfractures.
Symptoms
The main manifestation of ankle arthrosis is pain. The characteristic features of the pain syndrome in this disease are:
- the initial nature of the pain, when it is most pronounced at the beginning of the movement;
- of a mechanical nature, which leads to increased pain during physical activity and long walking;
- nocturnal aching pain caused by intraosseous stagnation of venous blood;
- blockage pain is a jam in the ankle joint, where the person cannot bend or straighten the leg, the pain increases significantly (the blockage is due to the jamming of fragments of dead cartilage between the joint surfaces);
- meteorological dependence - the pain intensifies when the weather changes, when it gets cold and the air humidity increases.
Ankle arthrosis is a chronic process. Painful periods, which indicate 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, in people starting at the age of 30, there is a gradual destruction of the cartilage plate, which exceeds the rate of formation of new cartilage. Therefore, the frequency of the disease increases with age. There are also certain gender characteristics. So, before menopause, female joints are protected from destruction. With the onset of the menopausal transition, the protective effect of estrogen gradually decreases, so, starting at the age of 50, the incidence of pathology in men and women becomes equal.
The following causes of ankle arthrosis have been 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 presents a special danger);
- previous inflammatory joint lesions;
- deformities of the ankle joint, which may be associated with flat feet, varus or valgus foot position;
- hereditary collagenopathies, especially those affecting collagen type 2 synthesis;
- ankle dysplasia;
- excessive body weight, which increases the load on the ankle joint and contributes to the "wiping out" of cartilage layers;
- the 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 you suspect osteoarthritis of the ankle joint, the doctor recommends an additional research program. It can consist of the following methods:
- Ultrasound scan - 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 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 visualizes osteophytes (using X-rays to detect the initial changes in osteoarthritis, which affect mainly the cartilage plate, is extremely difficult).
In severe 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 a layer-by-layer scan (scan step 2-3 mm) of the studied area and assess the state of the intra- and extra-articular structures of the ankle joint.
Expert opinion
Research has shown that hormones actively participate in the processes of growth and differentiation of cartilage tissue. Chondrocytes have been found to have receptors for thyroid hormones, insulin, glucocorticosteroids, growth hormone, male and female sex steroids, as well as prolactin. Disturbances of endocrine regulation are considered to be an important causative factor that can disrupt the balance between the process of cartilage formation and destruction, leading to dystrophy and degeneration. That is why it is 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 arthrosis of the ankle joint
Treatment of arthrosis in the initial stages is carried out by 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 in the stage of significant destruction of the cartilage plate and is accompanied by stiffness that interferes with human activities, endoprosthetics is indicated.
Conservative treatment
Conservative treatment of arthrosis begins with creating favorable conditions for joint functioning. Recommended:
- regular physical therapy exercises, swimming and water aerobics are also useful;
- normalization of body weight (if excess);
- use of crutches or orthopedic sticks during worsening of the process;
- wearing 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 cartilage. Symptomatic treatment with non-steroidal anti-inflammatory drugs is used to relieve pain.
Operation
Replacing the ankle joint is a rather complex task, so surgeons in a modern medical center strictly adhere to modern surgical methodology, which allows them to achieve the best therapeutic results. Currently, only third-generation implants are used in this operation, which require the removal of only a small fragment of bone. These prostheses stimulate osteoclasts (cells that form bone tissue), so they connect well with the tibia, fibula and talus, which ensures a special strength of the structure. The 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, which evenly distributes the load on the joint.
Ankle replacement surgery 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 arthrosis of the ankle joint
Prevention of arthrosis of the ankle joint consists of the following recommendations:
- wearing comfortable and non-compressive shoes, using orthopedic insoles;
- performing feasible physical exercises;
- using special ankle braces when playing professional sports;
- exclusion of jumping on the feet from a height;
- timely correction of accompanying deformities of the lower extremity.
Rehabilitation
After orthopedic intervention, temporary immobilization of the operated joint is performed. The period of immobility enables the creation of optimal conditions for the restoration of bone tissue and helps the implant to integrate as completely as possible. After removing the cast, health 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-orthopedic.
What is arthrodesis?
Arthrodesis is a surgical option previously used for osteoarthritis of the ankle joint. The operation implies immobilization of the joint, which negatively affects walking, but allows pain relief. 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 joint replacement?
After installing a third-generation implant, a person can engage in "gentle" sports - skiing, swimming, cycling and light running. You should avoid high impact sports – fast running, football, tennis, wrestling.