Deforming arthrosis most often affects the joints of the lower extremities, one of which is the ankle joint. These joints have great mobility in different planes and perform an important function when walking (rolling the feet and transferring body weight from heel to toe), and they can withstand the weight of the human body. Ankle osteoarthritis is a kind of revenge for upright walking. But many other factors play a role in the development of the disease. First, imperceptibly for the patient, the cartilage of the joint begins to soften and thin, then it bursts, which starts the inflammatory process, the growth of bone tissue in the form of osteophytes. With advanced osteoarthritis, a person cannot move without support and feels severe pain, especially when he leans on his leg. Disability is possible within a few years of the onset of the disease, if early and comprehensive treatment is not started.
Reasons for the development of diseases
Previous ankle injuries increase the likelihood of developing a degenerative process in it.
- Increased body weight;
- Flat feet, congenital foot deformities (horse foot, beating);
- Metabolic disorders in diseases such as diabetes mellitus, gout, atherosclerosis of the blood vessels of the legs;
- Previous joint injuries, for example, ligament damage, ankle fractures and foot bones;
- Constant overload of the joint, which leads to microtraumatization (in athletes and people who carry heavy loads);
- Hereditary predisposition to arthrosis of the joints;
- Previous arthritis (infectious arthritis) of 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 phases. In the presence of stage 1, a person is able to work, if arthrosis has progressed to stages 2 and 3, pain and limited mobility lead to disability (temporary or complete).
Symptoms of ankle osteoarthritis
- "Initial" pain. This is one of the early symptoms of osteoarthritis of the ankle. The pain occurs after sitting for a long time when trying to lean on the leg, it can be accompanied by short-term stiffness of movement in the joint. After a few steps, the pain disappears;
- Pain during and after physical exertion;
- Nocturnal aching pain is associated with an inflammatory process that is triggered by the destruction of cartilage tissue;
- Crunching, clicks in the joint during movement;
- Swelling, especially noticeable below the ankles;
- Restriction of movement;
- Hypotrophy of the periarticular muscles and weakness of the ligament apparatus due to the fact that the person begins to spare a sore leg;
- Joint deformity in the last stage of arthrosis.
It is necessary to distinguish arthrosis and its worsening from various inflammatory processes in the joint, for example, as a consequence of rheumatoid gout or psoriatic arthritis. That is why the doctor prescribes a detailed blood analysis, rheumatoid tests, CRP test, uric acid. In arthrosis, these indicators are normal, but if the disease is in the acute phase, ESR and leukocytes may be increased. Radiography in 2 projections, ultrasound, CT or MRI of the joint is used to determine the stage of arthrosis and obtain more detailed information about the pathology. An X-ray can show a slight narrowing of the joint space if the arthrosis is in the 1st phase. During the transition to the 2nd phase, the joint space is reduced by 40% or more than the norm. And in the 3rd phase it is significantly narrowed, it can be practically absent, growths and deformations of bones are visible.
Methods of treatment
Osteoarthritis of the ankle, as well as other localizations, includes complex, long-term and course treatment.
- Unloading of the ankle in the period of severe exacerbation (walking with a stick on the side of a healthy limb), use of bandages;
- Exclusion of shock loads (jumping, running), vibrations, weight transfer, prolonged stay on your feet;
- Weight control;
- Quit smoking;
- Wearing a semi-rigid orthosis with accompanying joint instability;
- Physiotherapy (UHF, SMT, laser therapy, magnetotherapy);
- Medical therapy:
- NSAIDs externally, orally, in injections;
- glucocorticoids together with anesthetics intraarticularly and periarticularly to relieve inflammation;
- vascular agents;
- muscle relaxants to relieve muscle spasm;
- chondroprotectors are more effective drugs administered intraarticularly. If it is not possible to receive intra-articular injections, intramuscular administration, oral administration is indicated;
- hyaluronic acid preparations to restore synovial fluid quality.
- Orthopedic insoles, wearing comfortable shoes with a small heel;
- Gymnastics to strengthen the musculoskeletal system. The following exercises should be done daily:
- lying down or sitting, bend and separate toes 10 times;
- lying down or sitting, pull your feet towards you and away from you 10 times;
- turn your feet outwards and inwards 10 times;
- make circular movements of the feet in a clockwise direction and counterclockwise 10 times;
- sitting on a chair, put your feet on the floor with joined toes and heels, alternately move your legs back and forth, repeat 15-20 times.
- Swimming, water aerobics;
- In the 3rd phase of arthrosis and ineffectiveness of conservative treatment, endoprosthetic replacement of the ankle joint or removal of the destroyed cartilage coating and joint capsule with its closure by means of a rod or Ilizarov apparatus (arthrodesis) is indicated.
- Avoid joint injuries. To do this, you must try not to wear shoes with unstable heels, too hard soles, use special protective equipment when doing sports;
- Weight control;
- You need to stick to a diet, that is, eat more protein-rich foods and refrain from salty, spicy, fried, alcohol;
- Timely treatment and correction of metabolic disorders, endocrine, vascular diseases;
- Perform the above ankle exercises.
To reduce the risk of developing osteoarthritis, preference should be given to protein-rich foods, and spicy, salty, fried foods and alcohol should be excluded from the diet.
The effectiveness of treatment of deforming osteoarthritis of the ankle depends on the stage of its development and the presence of concomitant diseases. In any case, if conservative therapy is indicated, it should include medication and physical methods, as well as correction with orthopedic products.
Which doctor to go to
In case of pain in the ankle, you should consult a rheumatologist. The doctor will prescribe exercises, medications and determine the cause of the disease. In the case of diabetes or gout, it will be useful to visit an endocrinologist, in the case of atherosclerosis of the blood vessels of the lower extremities - a vascular surgeon and cardiologist. An orthopedist plays an important role in the treatment - not only will he help you choose the right shoes, orthopedic insoles, but he will also perform surgery if necessary. If you are overweight, you need to visit a nutritionist and choose the right diet. Drug-free treatment is carried out with the participation of a physiotherapist.