Deforming osteoarthritis most often affects the joints of the lower extremities, one of which is the ankle. These joints have great mobility in different planes and perform an important function during walking (rotate the foot and transfer body weight from the heel to the toe) and also bear the weight of the human body. Osteoarthritis of the ankle joint is a kind of punishment for walking upright. But many other factors play a role in the development of the disease. First, imperceptibly for the patient, softening and thinning of the cartilage lining of the joint begins, then it breaks down, triggering the inflammatory process, the growth of bone tissue in the form of osteophytes. With advanced osteoarthritis, a person is unable to move without support and experiences severe pain, especially when relying on the 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 the disease
Previous injuries to the ankle joint increase the likelihood of a degenerative process developing in it.
- Weight gain
- Flat feet, congenital foot deformities (horse foot, clubfoot);
- Metabolic disorders in diseases such as diabetes mellitus, gout, atherosclerosis of the vessels of the legs;
- Past joint injuries, such as damage to the ligament system, fractures of the ankles and bones of the foot;
- Constant overload of the joint, leading to microtrauma (in athletes and people carrying heavy loads);
- Hereditary predisposition to arthrosis of the joints;
- Previous inflammation of the joint (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, osteoarthritis of the ankle can be primary or secondary. There is also a division into stages. In the presence of the 1st stage, a person is unable to work, if arthrosis has passed to the 2nd and 3rd stages, pain and reduced mobility lead to disability (temporary or complete).
Symptoms of osteoarthritis of the ankle
- "Starting" pain. This is one of the first symptoms of osteoarthritis of the ankle joint. Pain appears after prolonged sitting when trying to lean on the leg, it may be accompanied by short-term stiffness in the movements of the joint. After taking a few steps, the pain disappears;
- Pain during and after physical exertion;
- Aching pain at night, is associated with an inflammatory process that is triggered by the destruction of cartilage tissue;
- Crunch, snaps into the joint during movement;
- Swelling, especially noticeable under the ankles
- Movement restriction;
- Hypotrophy of the periarticular muscles and weakness of the ligament apparatus due to the fact that a person begins to spare the sore 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, due to rheumatoid gout or psoriatic arthritis. Therefore, the doctor prescribes a detailed blood test, rheumatoid tests, a test for PCR, uric acid. With osteoarthritis, these indicators are normal, but if the disease is in the acute stage, the ESR and leukocytes may be increased. To establish the stage of arthrosis and obtain more detailed information about the pathology, radiography in 2 views, ultrasound, CT or MRI of the joint is used. A slight narrowing of the joint space can be seen on the x-ray if osteoarthritis is in the 1st stage. During the transition to the 2nd stage, the joint space is reduced by 40% or more than normal. And in the 3rd stage, it is significantly narrowed, it can be practically absent, growths and deformations of the bones are visible.
Methods of treatment
Arthrosis of the ankle joint, as well as other localizations, involves complex, long-term and ongoing treatment.
- Unloading the ankle joint during a period of severe exacerbation (walking with a cane on the side of a healthy limb), the use of a bandage;
- Exclusion of shock loads (jumping, running), vibrations, weight transfer, prolonged stay on the legs;
- Body weight control;
- Stop smoking;
- Wearing a semi-rigid orthosis with concomitant joint instability;
- Physiotherapy (UHF, SMT, laser therapy, magnetotherapy);
- Medical therapy:
- NSAID externally, orally, injections;
- glucocorticoids along with intraarticular and periarticular anesthetics to relieve inflammation;
- vascular agents;
- muscle relaxants to eliminate spasm of muscle tissue;
- chondroprotectors are more effective drugs administered intraarticularly. If it is not possible to receive intra-articular injections, intramuscular administration is indicated, oral administration;
- preparations of hyaluronic acid to restore the quality of synovial fluid.
- Orthopedic insoles, wearing comfortable shoes with a small heel;
- Gymnastics to strengthen the musculoskeletal system. The following exercises should be performed daily:
- lying or sitting, bend and straighten your toes 10 times;
- lying or sitting, pull your feet towards you and away from you 10 times;
- turn the feet and in 10 times;
- make circular movements with the feet clockwise and counterclockwise 10 times;
- sitting on a chair, put your feet on the floor with your toes and heels together, rearrange your legs alternately back and forth, repeat 15-20 times.
- Swimming, water aerobics;
- In the 3rd stage of arthrosis and ineffectiveness of conservative treatment, replacement of the endoprosthesis of the ankle joint or removal of the destroyed cartilage lining and joint capsule with its closure with the help of a rod structure is indicated or the Ilizarov apparatus (arthrodesis).
- Avoid joint injuries. To do this, you need to try not to wear shoes with unstable heels, too hard soles, use special protective equipment when doing sports;
- Check your body weight;
- It is necessary to stick to a diet, that is, eat more protein-rich foods and refrain from salty, spicy, fried alcohol;
- Promptly treat and correct metabolic disorders, endocrine and vascular diseases;
- Perform the above exercises for the ankle joints.
To reduce the risk of developing osteoarthritis, food should be preferred over protein-rich foods, and spicy, salty, fried and alcoholic foods should be excluded from the diet.
The effectiveness of the 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 drugs and physical methods, as well as correction with orthopedic products.
Which doctor to contact
For pain in the ankle joint, you should consult a rheumatologist. The doctor will prescribe exercises, medications 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 physiotherapist.