Arthrosis of the ankle joint

Arthrosis 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 development of the process

This disease mainly begins with damage to the base of the joint cartilage. Under the influence of unfavorable factors, the cartilage becomes thinner, fibrous and cracked, which contributes to the exposure of the underlying bone. During movement in the joint, the exposed bone experiences a non-physiological load, so it tries to "protect itself". This gives rise to compensatory osteosclerosis (hardening) in the underlying subchondral zone, as well as the development of secondary subchondral cysts. In response, the ideal relationship of the articular surface is disturbed, which worsens the pathological process. As the disease progresses, newly formed bone tissue forms growths (osteophytes) at the edges, which cause severe pain.

Deformed ankle osteoarthritis can be caused by a variety of factors. This may be genetics, trauma, 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 movement in the ankle. This disease is also characterized by symptoms of crepitus (crunching), 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 scans of the joints and radiographs help to establish the correct diagnosis. In complex cases, computed tomography or magnetic resonance imaging may be necessary.

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, incl. by the intra-articular route of administration. Nonsteroidal anti-inflammatory drugs (and in severe cases, steroids) help relieve pain. In case of severe destruction of the joint, endoprosthesis replacement is performed using a third-generation prosthesis, which is fully integrated with the bone.

Type

What is the meaning of arthrosis of the ankle joint, taking into account the mechanism of development? According to the classification, there are 2 variants of the disease:

• primary osteoarthritis, which is also called idiopathic, when it is not possible to determine the exact cause of the disease even with the most modern examination;
• secondary arthrosis, which is caused by the influence of obvious causative factors or the factors listed above.

In clinical medicine, there are 6 degrees of ankle arthrosis:

• in the first stage, the superficial zone of cartilage is not damaged, but there is swelling and fragmentation of the matrix, chondrocytes multiply, and the type of collagen they synthesize changes (normally, the cartilage plate is formed by collagen of the second type. , and in arthrosis it is replaced by less collagen of the third typelong lasting);
• in the second stage, the integrity of the superficial zone of the cartilaginous plate is disturbed, the location of chondrocytes in the deep zone changes;
• in the third stage, the development of the pathological process leads to the appearance of vertical cracks;
• in the fourth stage, the superficial zone of cartilage peels off, the surface is eroded and cysts appear;
• the fifth degree is characterized by exposure of the underlying bone;
• in the sixth stage, compensatory changes occur in the bone tissue, consisting of its compaction, osteophyte formation and micro-fractures.

symptoms

The main manifestation of ankle arthrosis is pain. The characteristic features of the pain syndrome in this disease are:

• early nature of pain, when it is most noticeable at the beginning of movement;
• mechanical nature, which leads to increased pain during physical activity and long walks;
• painful night pain caused by intraosseous stagnation of venous blood;
• restriction pain is congestion in the ankle, where a person cannot bend or straighten the leg, because the pain increases significantly (restriction occurs because fragments of dead cartilage are stuck between the articular surfaces);
• meteorological dependence - the pain increases when the weather changes, when it gets colder and the air humidity increases.

Ankle arthrosis is a chronic process. Painful periods, which indicate an exacerbation of the disease, alternate with painless ones. As osteoarthritis progresses, the period between relapses becomes shorter, and at some stage the pain may become permanent.

Causes of ankle arthrosis

On average, in people starting at the age of 30, the gradual destruction of cartilage plates 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. Therefore, before menopause, women's joints are protected from destruction. With the onset of the menopause transition, the protective effect of estrogen gradually decreases, therefore, starting from the age of 50, the incidence of pathology in men and women is equal.

The following causes of arthrosis of the ankle joint are identified, which lead to the fact that the process of re-synthesis of cartilage tissue does not have time to cover the catabolism (destruction) of cartilage:

• suffered a traumatic injury (jumping from a height poses certain dangers);
• previous inflammatory lesions of the joints;
• ankle deformity, which may be associated with flat feet, varus or valgus position of the foot;
• hereditary collagenopathies, particularly those affecting collagen type 2 synthesis;
• ankle dysplasia;
• excess body weight, which increases the load on the ankle and contributes to the "erasure" of the cartilage layer;
• menopausal period (the average age of permanent cessation of menstruation in women is 50-52 years);
• metabolic disorders;
• sedentary lifestyle;
• previous orthopedic intervention on the joint;
• recurrent hypothermia.

Diagnostics

If you suspect osteoarthritis of the ankle joint, the doctor recommends an additional research program. It may consist of the following methods:

• Ultrasound scanning - the study allows you to assess the structural condition of the soft tissues of the joint (cartilage, synovial bursa and surrounding tissue), this is the most informative method for the early diagnosis of arthrosis changes;
• X-ray - this method mainly evaluates the structure of bone tissue, helps to identify subchondral osteosclerosis, the presence of cysts in the subchondral zone, and also describes osteophytes (using X-ray to detect early changes in osteoarthritis, which mainly affects the cartilaginous plate, is very difficult).

In difficult clinical cases, computed tomography or magnetic resonance imaging can be used to detail the condition of the ankle joint. Each of these methods allows you to obtain a layer-by-layer scan (scanning step 2-3 mm) of the studied area and assess the condition of the intra- and extra-articular structures of the ankle.

Expert opinion

Studies have shown that hormones take an active part in the process of growth and differentiation of cartilage tissue. It has been established that chondrocytes have receptors for thyroid hormones, insulin, glucocorticosteroids, growth hormones, male and female sex steroids, as well as prolactin. Disruption of endocrine regulation is considered an important causative factor that can disrupt the balance between the process of cartilage formation and destruction, further leading to dystrophy and degeneration. Therefore, it is very important to monitor the state of endocrine-metabolic reactions in the body, conduct a screening test to assess the functional state of the thyroid gland, and contact an endocrinologist at the first suspicious symptoms.

Treatment of ankle arthrosis

Treatment of arthrosis in the early stages is carried out using conservative methods. Timely therapy can protect the joint from destruction and delay or completely avoid the need for surgical intervention. If the disease is detected at the stage of significant cartilage plate destruction 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 joint function. Recommended:

• regular physical therapy exercises, swimming and water aerobics are also useful;
• weight normalization (if excessive);
• the use of crutches or orthopedic crutches during the aggravation process;
• wear comfortable orthopedic shoes.

To improve the condition of the cartilage plates, chondroprotectors are used, which are injected mainly into the joints. Hyaluronic acid and PRP therapy (plasma therapy) restore the condition of cartilage plates. To relieve pain, symptomatic treatment is carried out using non-steroidal anti-inflammatory drugs.

Surgery

Ankle joint replacement is a rather complex task, so surgeons in modern medical centers adhere to modern surgical methodology, which allows them to achieve the best therapeutic results. Currently, this operation only uses third-generation implants, which require the removal of only small bone fragments. This prosthesis stimulates osteoclasts (cells that form bone tissue), so it is well fused with the tibia, fibula and talus, which ensures the strength of the special structure. A unique feature of the third generation prosthesis is that it allows movement of not only the main joint, but also the articulation between the fibula and the tibia, thus distributing the load evenly on the joint.

Surgical intervention for ankle replacement also involves correcting the existing deformity and suturing the damaged ligaments. This creates good conditions to maintain the stability of the joint and fully ensure its function.

Prevention of ankle arthrosis

Prevention of arthrosis of the ankle joint consists of following the following recommendations:

• wearing comfortable and non-compressive shoes, using orthopedic insoles;
• perform physical exercises that are feasible;
• the use of special ankle braces when playing professional sports;
• exclusion of jumping with feet from a height;
• timely correction of concomitant deformities of the lower limbs.

Restoration

After orthopedic intervention, temporary immobilization of the operated joint is performed. The period of immobility allows you to create optimal conditions for the restoration of bone tissue and helps the implant to fully integrate. After removing the plaster cast, health-improving gymnastics under the supervision of a physical therapist, massage and physiotherapy are indicated.

Question and answer

Which doctor treats ankle arthrosis?

Diagnosis and treatment of this disease is carried out by a traumatologist-orthopedic.

What is arthrodesis?

Arthrodesis is a surgical option previously used for ankle arthrosis. Surgery involves immobilization of the joint, which negatively affects gait, but allows for pain relief. 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, football, tennis, wrestling.