Arthrosis of the ankle joint is a degenerative-dystrophic damage to the cartilage plate of the joint and the underlying bone.
About the aggravation and progression of the disease
The disease first begins with damage to the cartilaginous base of the joint. Under the influence of adverse factors, the cartilage becomes thinner, fibers and cracks are formed, which contributes to the exposure of the underlying bone. During the movements in the joint, the open bone experiences a non-physiological load, so it tries to "protect itself". This causes compensatory osteosclerosis (hardening) in the primary subchondral zone and the development of secondary subchondral cysts. In response to this, the ideal connections of the articular surfaces are disturbed, which aggravates the pathological process. As the disease progresses, newly formed bone tissue forms growths (osteophytes) at the edges that cause severe pain.
A variety of factors can cause deforming osteoarthritis of the ankle. These can be genetic, traumatic, growth and metabolic conditions. The initial destruction of articular cartilage gradually leads to damage to all tissues of synovial joints.
The main clinical symptoms of osteoarthritis are ankle pain and limited mobility. The disease is also characterized by the symptom of 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, ultrasound examination of the joints and radiography help to make 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 condition of the cartilage plate, chondroprotectors are prescribed, including. by intra-articular administration. Non-steroidal (and in particularly severe cases, steroids) anti-inflammatory drugs help relieve pain. In case of severe destruction of the joint, replacement of the endoprosthesis is carried out using third-generation prostheses that are fully integrated with the bone.
Species
Considering the mechanisms of development, what does arthrosis of the ankle joint mean? According to the classification, there are 2 variants of the disease:
- primary osteoarthritis, called idiopathic, when the true cause of the disease cannot be determined even with the most up-to-date examination;
- secondary arthrosis caused by a clearly defined causative factor or the effects of the factors listed above.
In clinical medicine, there are 6 degrees of ankle arthrosis:
- in the first degree, the surface zone of the cartilage is not damaged, but the matrix swells and breaks down, the chondrocytes multiply and the type of collagen they synthesize changes (normally, the cartilage plate is formed by the second type of collagen). , and in arthrosis it is replaced by less durable collagen of the third type);
- in the second degree, the integrity of the surface zone of the cartilage plate is violated, the location of chondrocytes in the deep zone changes;
- the progression of the pathological process in the third degree causes 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 main bone;
- in the sixth degree, compensatory changes occur in the bone tissue, which consists of its compression, the formation of osteophytes and microfractures.
Symptoms
The main manifestation of ankle arthrosis is pain. Distinctive features of pain syndrome in this disease are:
- the initial nature of the pain, when it is most expressed at the beginning of the movement;
- mechanical nature that causes increased pain during physical activity and long walking;
- aching pain at night caused by intraosseous stagnation of venous blood;
- block pain is a tightness in the ankle, in which a person cannot bend or straighten the leg, because the pain increases significantly (blockage occurs due to the fact that pieces of dead cartilage are stuck between the articular surfaces);
- meteorological dependence - the pain intensifies when the weather changes, becomes colder, and the air humidity increases.
Ankle arthrosis is a chronic process. Painful periods that indicate the exacerbation of the disease are replaced by painless ones. As arthrosis progresses, the period between relapses shortens, and at some stage the pain can be permanent.
Causes of ankle arthrosis
On average, in people starting at the age of 30, a gradual destruction of the cartilage plate occurs, which exceeds the rate of formation of new cartilage. Therefore, the prevalence of the disease increases with age. There are also certain gender characteristics. Thus, the joints of women before menopause are protected from destruction. With the onset of menopause, the protective effect of estrogens gradually decreases, so the frequency of pathology in men and women equals from the age of 50.
The following causes of arthrosis of the ankle joint are identified, which lead to the fact that the process of cartilage tissue resynthesis does not have time to cover cartilage catabolism (destruction):
- traumatic injuries (jumping from a height poses a special danger);
- previous inflammatory lesions of the joint;
- flat feet, ankle deformities that may be associated with varus or valgus position of the foot;
- hereditary collagenopathies, especially those affecting the synthesis of type 2 collagen;
- ankle dysplasia;
- excess body weight, which increases the load on the ankle and helps to "wipe" the cartilage layers;
- postmenopausal period (the average age of permanent cessation of menstruation in women is 50-52 years);
- metabolic disorders;
- sedentary lifestyle;
- joint previous orthopedic interventions;
- repeated hypothermia.
Diagnostics
If you suspect arthrosis of the ankle joint, the doctor recommends an additional research program. It can consist of the following methods:
- Ultrasound examination - the study allows assessing the state of joint soft tissue structures (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 determine the presence of subchondral osteosclerosis, cysts in the subchondral zone, and also helps to visualize osteophytes (using x-ray to detect initial changes in osteoarthritis, mainly affecting the cartilaginous plate. , extremely difficult).
In difficult clinical cases, computed tomography or magnetic resonance imaging can be used to detail the condition of the ankle. Each of these methods allows obtaining layer-by-layer scans of the studied area (scan step 2-3 mm) and assessing the condition of the intra-articular and extra-articular structures of the ankle.
Expert opinion
Studies have shown that hormones are actively involved in the growth and differentiation of cartilage tissue. It was determined that chondrocytes contain thyroid hormones, insulin, glucocorticosteroids, growth hormone, male and female sex steroids, as well as prolactin receptors. Endocrine dysregulation is considered an important causative factor 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 endocrine-metabolic reactions in the body, perform screening examinations to assess the functional state of the thyroid gland, and contact an endocrinologist at the first suspicious symptoms.
Treatment of ankle arthrosis
In the initial stages, arthrosis is treated using conservative methods. Timely therapy can protect the joint from destruction and delay, or completely eliminate 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 are indicated.
Conservative treatment
Conservative treatment of arthrosis begins with creating favorable conditions for the functioning of the joint. Recommendation:
- regular physical therapy exercises, swimming and water aerobics are also useful;
- normalization of body weight (if there is excess);
- the use of an ax or orthopedic canes during exacerbation of the process;
- wear 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 is carried out using non-steroidal anti-inflammatory drugs to relieve pain.
Surgery
Replacing the ankle joint is a very complex task, therefore surgeons at the modern medical center strictly adhere to the modern surgical methodology that allows to achieve the best therapeutic results. Currently, third-generation implants are used in this operation, which only require the removal of a small piece of bone. These prostheses stimulate osteoclasts (cells that form bone tissue), so they bond well with the tibia, fibula, and talus, which provides special structural strength. The unique feature of the third-generation prosthesis is that it allows movement not only of the main joint, but also of the joint between the fibula and tibia, thereby distributing the load evenly on the joint.
Ankle replacement surgery also involves correcting existing deformities and repairing 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 the following recommendations:
- wear comfortable and non-tight shoes, use orthopedic insoles;
- performance of possible physical exercises;
- use of special ankle braces when practicing professional sports;
- exclusion of standing jumps;
- 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 allows creating optimal conditions for the regeneration of bone tissue and contributes to the most complete integration of the implant. After the cast is removed, rehabilitation gymnastics, massage and physiotherapy are performed under the supervision of a physiotherapist.
Questions and answers
Which doctor treats ankle arthrosis?
Diagnosis and treatment of the disease is carried out by a traumatologist-orthopedic.
What is arthrodesis?
Arthrodesis is a surgical option previously used for ankle arthrosis. The operation involves immobilization of the joint, which adversely affects walking, but allows to relieve pain. Therefore, endoprosthesis replacement is considered a more optimal and physiological option for surgical treatment of ankle osteoarthritis.
Is it possible to play sports after ankle replacement?
After installing the 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.