Arthrosis deformans most often affects the joints of the lower extremities, one of which is the ankle. These joints have great mobility in different planes and play an important role when walking (rolling the foot and transferring body weight from the heel to the toe), in addition to supporting the weight of the human body. Osteoarthritis of the ankle joint is a kind of retribution for walking upright. But many other factors play a role in the development of the disease. First, imperceptibly to the patient, the softening and thinning of the cartilaginous lining of the joint begins, then it cracks, which triggers the inflammatory process, the growth of bone tissue in the form of osteophytes. With advanced osteoarthritis, a person is not able to move without support and experiences severe pain, especially when leaning on the leg. Disability is possible within a few years after the onset of the disease if early and comprehensive treatment is not started.
Reasons for the development of the disease
Previous injuries to the ankle joint increase the likelihood that a degenerative process will develop in it.
- Increase in body weight;
- Flat feet, congenital foot deformities (horsefoot, clubfoot);
- Metabolic disorders in diseases such as diabetes mellitus, gout, atherosclerosis of the vessels of the legs;
- Previous joint injuries, eg damage to the ligament apparatus, fractures of the ankles and foot bones;
- Constant overloading of the joint, leading to microtraumatization (in athletes and people who carry heavy loads);
- Hereditary predisposition to arthrosis of the joints;
- Previous joint inflammation (arthritis) of an infectious nature or with systemic diseases (rheumatoid, psoriatic, gouty arthritis).
Depending on the absence or presence of a specific factor that caused the disease, ankle osteoarthritis can be primary or secondary. There is also a division into stages. In the presence of the 1st stage, a person is able to work, if the arthrosis has passed to the 2nd and 3rd stages, pain and limited mobility lead to disability (temporary or complete).
Symptoms of Ankle Osteoarthritis
- "Initial" pain. This is one of the first symptoms of ankle joint osteoarthritis. The pain appears after sitting for a long time when trying to lean on the leg, it may be accompanied by stiffness of movements in the joint in the short term. After a few steps, the pain disappears;
- Pain during and after physical exertion;
- Painful nocturnal pain, is associated with an inflammatory process that is triggered due to the destruction of cartilage tissue;
- Crunch, clicks on joint during movement;
- Swelling, especially noticeable under the ankles;
- Restriction of movements;
- Hypotrophy of the periarticular muscles and weakness of the ligament apparatus due to the fact that a person begins to spare the painful leg;
- Joint deformity in the last stage of arthrosis.
It is necessary to distinguish arthrosis and its exacerbation from various inflammatory processes in the joint, for example, as a result of rheumatoid arthritis or psoriatic arthritis. Therefore, the doctor prescribes a detailed blood test, rheumatoid tests, PCR test, uric acid. With osteoarthritis, these indicators are normal, but if the disease is in the acute stage, ESR and leukocytes may be increased. To establish the stage of arthrosis and obtain more detailed information about the pathology, 2-view radiography, ultrasonography, computed tomography or magnetic resonance imaging of the joint are used. On radiography, a slight narrowing of the joint space can be seen if the arthrosis is in the 1st stage. During the transition to stage 2, the joint space is reduced by 40% or more of the norm. And in the 3rd stage, it is significantly narrowed, it can be practically absent, bone growths and deformations are visible.
Osteoarthritis of the ankle joint, like other locations, involves complex, long-term, and ongoing treatment.
- Unloading the ankle joint during a period of severe exacerbation (walking with a cane alongside a healthy limb), dressing use;
- Exclusion of shock loads (jumping, running), vibration, weight transfer, prolonged stay in the legs;
- Body weight control;
- Quit smoking;
- Use of semi-rigid orthosis with concomitant joint instability;
- Physiotherapy (UHF, SMT, laser therapy, magnetic therapy);
- Medical therapy:
- NSAIDs externally, orally, in injections;
- glucocorticoids in conjunction with intra- and periarticular anesthetics to relieve inflammation;
- vascular agents;
- muscle relaxants to eliminate muscle tissue spasm;
- chondroprotectors are more effective drugs administered intra-articularly. If it is not possible to receive intra-articular injections, intramuscular, oral administration is indicated;
- hyaluronic acid preparations to restore the quality of synovial fluid.
- Orthopedic insoles, wearing comfortable shoes with small heels;
- Gymnastics to strengthen the musculoskeletal system. The following exercises should be done daily:
- lying or sitting, bend and unfold your toes 10 times;
- lying or sitting, pull your feet towards you and away from you 10 times;
- turn the feet out and in 10 times;
- make circular movements with your feet clockwise and counterclockwise 10 times;
- sitting on a chair, place your feet on the floor with your toes and heels together, alternately rearrange your legs back and forth, repeat 15-20 times.
- Swimming, water aerobics;
- In the 3rd stage of arthrosis and in the ineffectiveness of conservative treatment, replacement of the ankle joint endoprosthesis or removal of the destroyed cartilaginous lining and the joint capsule with its closure with the help of a rod structure or the Ilizarov apparatus is indicated. (arthrodesis).
- Avoid joint injuries. To do this, you should try not to wear shoes with unstable heels, very hard soles, wear special protective equipment when playing sports;
- Control body weight;
- You need to follow a diet, that is, eat more protein-rich foods and refrain from salty, spicy, fried foods, alcohol;
- Timely treat and correct metabolic disorders, endocrine and vascular diseases;
- Perform the exercises above for ankle joints.
To reduce the risk of developing osteoarthritis, food should be given preference to foods rich in protein, and spicy, salty, fried foods and alcohol should be excluded from the diet.
The effectiveness of treatment of deforming arthrosis of the ankle joint 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 medication and physical methods, in addition to correction with orthopedic products.
Which doctor to contact
For ankle joint pain, you should consult a rheumatologist. The doctor will prescribe exercises, medication and identify the cause of the disease. In case of diabetes or gout, it will be useful to visit an endocrinologist, in case of atherosclerosis of the vessels of the lower extremities - a vascular surgeon and a cardiologist. An orthopedist plays an important role in the treatment - he will not only help you choose the right shoes, orthopedic insoles, but will also perform an operation if necessary. If you are overweight, you need to consult a nutritionist and select the right diet. Non-drug treatment is carried out with the participation of a physical therapist.