Osteoarthritis of the ankle joint is a degenerative-dystrophic lesion of the cartilaginous plate of the joint and the underlying bone.
About the disease, exacerbation and progression of the process
The disease begins mainly with damage to the cartilaginous base of the joint. Under the influence of adverse factors, the cartilage thins, cracks and cracks, which contributes to exposing the underlying bone. During joint movements, the exposed bone experiences a non-physiological load, so it tries to "protect itself". This causes compensatory osteosclerosis (hardening) in the underlying subchondral area, as well as the development of secondary subchondral cysts. In response, the ideal relationships of the joint surfaces are disrupted, further aggravating the disease process. As the disease progresses, the newly formed bone tissue forms growths (osteophytes) at the edges, which cause severe pain.
Deforming osteoarthritis of the ankle can be caused by a variety of factors. These can include genetic, traumatic, growth, and metabolic conditions. The initial destruction of articular cartilage gradually leads to damage to all synovial joint tissues.
The main clinical signs of osteoarthritis are pain and limited mobility of the ankle. The disease is also characterized by the symptom of crepitus (cracking), the periodic appearance of effusion in the synovial cavity, as well as the secondary development of the inflammatory process. In addition to a clinical examination, ultrasound of the joints and x-rays help establish the correct diagnosis. In complex cases, a CT scan or magnetic resonance imaging may be necessary.
Treatment of ankle osteoarthritis is usually carried out using conservative methods. To improve the functional state of the cartilaginous plate, chondroprotectors are prescribed, incl. with an intra-articular route of administration. Nonsteroidal anti-inflammatory drugs (and in particularly severe cases, steroids) help relieve pain. In the event of severe destruction of the joint, replacement by endoprosthesis is carried out using third generation prostheses, fully integrated into the bone.
Types
What does ankle osteoarthritis mean, considering the mechanisms of development? According to the classification, there are 2 variants of the disease:
- primary osteoarthritis, also called idiopathic, when it is not possible to establish the true cause of the disease even with the most modern examination;
- secondary osteoarthritis, caused by the influence of one or more clearly defined causal factors listed above.
In clinical medicine, there are 6 degrees of ankle osteoarthritis:
- in the first degree, the superficial area of the cartilage is not damaged, but there is swelling and disintegration of the matrix, the chondrocytes proliferate and the type of collagen they synthesize changes (normally, the cartilaginous plate is formed from collagen of thesecond type, and in osteoarthritis it is replaced by less durable collagen of the third type);
- at the second degree, the integrity of the superficial zone of the cartilaginous plate is disrupted, the location of chondrocytes in the deep zone changes;
- in the third degree, the progression of the pathological process leads to the appearance of vertical cracks;
- at the fourth degree, the superficial area of the cartilage becomes detached, eroded surfaces and cysts appear;
- the fifth degree is characterized by exposure of the underlying bone;
- at the sixth degree, compensatory changes occur in bone tissue, which consist of its compaction, the formation of osteophytes and microfractures.
Symptoms
The main manifestation of ankle osteoarthritis is pain. Distinctive features of pain syndrome in this disease are:
- the initial nature of the pain, when it is most pronounced at the beginning of the movement;
- mechanical in nature, which leads to increased pain during physical activity and long walks;
- night pain caused by intraosseous stagnation of venous blood;
- blockade pain is jamming of the ankle, in which a person cannot bend or straighten the leg, because the pain increases significantly (blockage occurs due to fragments of dead cartilage stuck between the joint surfaces);
- weather dependence - pain intensifies when the weather changes, when it gets colder and air humidity increases.
Ankle osteoarthritis is a chronic process. Painful periods, which indicate an exacerbation of the disease, alternate with painless periods. As osteoarthritis progresses, the interval between flare-ups shortens, and at some stage the pain may become permanent.
Causes of ankle osteoarthritis
On average, in people from the age of 30, a gradual destruction of the cartilaginous plate occurs, exceeding the rate of formation of new cartilage. The prevalence of the disease therefore increases with age. There are also certain gender characteristics. Thus, before menopause, women's joints are protected from destruction. With the onset of the menopausal transition, the protective effect of estrogen gradually diminishes. Thus, from the age of 50, the incidence of the pathology in men and women equalizes.
The following causes of osteoarthritis of the ankle joint are 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 poses a particular danger);
- previous inflammatory lesions of the joint;
- ankle deformities, which may be associated with flat feet, varus or valgus position of the foot;
- hereditary collagenopathies, particularly those affecting the synthesis of type 2 collagen;
- ankle dysplasia;
- excess body weight, which increases the load on the ankle and contributes to the "erasure" of the cartilaginous layers;
- postmenopausal period (the average age of persistent cessation of menstruation in women is 50-52 years);
- Metabolic disorders;
- sedentary lifestyle;
- previous orthopedic interventions on the joint;
- repeated hypothermia.
Diagnostic
If you suspect ankle osteoarthritis, the doctor recommends an additional research program. These can be the following methods:
- Ultrasound - the study allows you to assess the state of the soft tissue structures of the joint (cartilage, synovial bursa and surrounding tissues), this is the most informative method for early diagnosis of changes in osteoarthritis;
- X-ray - this method mainly assesses the structure of bone tissue, helps to identify subchondral osteosclerosis, the presence of cysts in the subchondral area, and also visualizes osteophytes (using X-rays to detect initial changes in theOsteoarthritis, mainly affecting the cartilaginous plate, is extremely difficult).
In difficult clinical cases, CT or magnetic resonance imaging can be used to detail the condition of the ankle joint. Each of these methods allows you to obtain layer-by-layer scans (scanning step 2-3 mm) of the studied area and to assess the state of the intra- and extra-articular structures of the ankle.
Expert opinion
Studies have shown that hormones actively participate in the processes of growth and differentiation of cartilage tissue. It has been established that chondrocytes have receptors for thyroid hormones, insulin, glucocorticosteroids, growth hormone, male and female sex steroids, as well as prolactin. Endocrine regulation disorders are considered an important causal factor that can disrupt the balance between the process of cartilage formation and destruction, thereby leading to dystrophy and degeneration. Therefore, it is so important to monitor the state of endocrine and 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 ankle osteoarthritis
Treatment of osteoarthritis in the early stages is carried out using conservative methods. Prompt treatment can protect the joint from destruction and delay or avoid the need for surgery altogether. If the disease is detected at the stage of significant destruction of the cartilaginous plate and is accompanied by stiffness that interferes with human activity, endoprostheses are indicated.
Conservative treatment
Conservative treatment of osteoarthritis begins with creating favorable conditions for the functioning of the joint. Recommended:
- regular physiotherapy, swimming and water aerobics exercises are also helpful;
- normalization of body weight (if it is excess);
- use of crutches or orthopedic canes during exacerbation of the process;
- wear comfortable orthopedic shoes.
To improve the condition of the cartilaginous plate, chondroprotectors are used, which are injected mainly into the joint. Hyaluronic acid and PRP therapy (plasma therapy) restore the condition of the cartilage plate. To relieve pain, symptomatic treatment is carried out using nonsteroidal anti-inflammatory drugs.
Surgery
Ankle arthroplasty is a rather complex task, therefore surgeons of a modern medical center strictly adhere to modern surgical methodology, which allows them to achieve the best therapeutic results. Currently, this operation only uses third generation implants, which only require the removal of a small bone fragment. These prostheses stimulate osteoclasts (cells that form bone tissue), so that they fuse well with the tibia, fibula and talus, guaranteeing particular structural strength. A 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 the tibia, thereby evenly distributing 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 ankle osteoarthritis
Prevention of ankle osteoarthritis involves following the following recommendations:
- wear comfortable, non-compressive shoes, use orthopedic insoles;
- perform feasible physical exercises;
- use of special ankle braces when playing professional sports;
- exclusion of jumping on feet from a height;
- rapid correction of concomitant deformities of the lower limb.
Rehabilitation
After orthopedic intervention, temporary immobilization of the operated joint is carried out. The period of immobility creates optimal conditions for the restoration of bone tissue and helps the implant to integrate as much as possible. After removing the cast, health-improving gymnastics under the supervision of a physiotherapist doctor, massage and physiotherapy are indicated.
Questions and answers
Which doctor treats ankle osteoarthritis?
Diagnosis and treatment of the disease is carried out by a traumatologist-orthopedist.
What is arthrodesis?
Arthrodesis is a surgical option that has already been used for ankle osteoarthritis. The operation involves immobilization of the joint, which negatively affects gait, but helps relieve pain. 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 replacement?
After installing a third-generation implant, a person can engage in "soft" sports: skiing, swimming, cycling and light jogging. You should avoid high-impact sports – fast running, soccer, tennis, wrestling.