ankle arthritis

Arthropathies of the ankle joint are degenerative dystrophic lesions of the articular cartilage plate and underlying bone.

About the disease, exacerbations and progression

The disease primarily begins with damage to the cartilage base of the joints. Under the influence of adverse factors, cartilage thins, becomes fibrotic, and cracks, resulting in exposure of the underlying bone. During joint movement, the exposed bone is subjected to non-physiological loads, so it attempts to "protect itself". This causes compensatory osteosclerosis (hardening) of the underlying subchondral area, and the development of secondary subchondral cysts. In response, the ideal relationship of the articular surfaces is disrupted, which further exacerbates the pathological process. As the disease progresses, new bone tissue forms growths (osteophytes) around the edges, causing severe pain.Deforming osteoarthritis of the ankle can be caused by a variety of factors. These may be genetics, trauma, growth and metabolic conditions. The initial destruction of articular cartilage gradually leads to damage to all tissues of the synovial joint.The main clinical symptoms of osteoarthritis are ankle pain and limited mobility. The disease is also characterized by crepitus (crunching) symptoms, periodic accumulation of fluid in the synovial cavity, and secondary development of inflammatory processes. In addition to clinical examination, joint ultrasound scans and radiographs help establish the correct diagnosis. In complex cases, computed tomography or magnetic resonance imaging may be required.Ankle arthritis is usually treated conservatively. To improve the functional status of the cartilage plate, chondroprotective agents are required, including. Use the intra-articular route of administration. Nonsteroidal (and, in particularly severe cases, steroidal) anti-inflammatory drugs can help relieve pain. If the joint is severely damaged, endoprosthetic replacement is performed using a third-generation prosthesis that is fully integrated with the bone.

type

What does arthritis of the ankle joint mean given developmental mechanisms? According to the classification, there are 2 variants of the disease:

• In primary osteoarthritis, also called idiopathic, the true cause of the disease cannot be determined even with the most modern tests;
• Secondary arthropathy is caused by clear causative factors or the influence of the above factors.

Clinically, the ankle joint is divided into 6 degrees:

• In the first degree, the cartilage surface is not damaged, but the matrix swells and disintegrates, chondrocytes proliferate, the type of collagen synthesized changes (usually the cartilage plate is formed of type II collagen), and in arthropathy it is replaced by a third type of collagen. a less durable collagen replacement);
• In the second degree, the integrity of the superficial cartilage plate is destroyed, and the position of the deep cartilage cells changes;
• In the third degree, the progression of pathological processes leads to the appearance of vertical cracks;
• In the fourth degree, the cartilage surface peels off, and erosion surfaces and cysts appear;
• The fifth degree is characterized by exposure of the underlying bone;
• In the sixth degree, compensatory changes in bone tissue occur, including compaction, osteophyte formation, and microfractures.

symptom

The main symptom of the ankle joint is pain. Distinctive features of the pain syndrome of this disease are:

• The initial nature of the pain, most evident at the onset of movement;
• Mechanical in nature, resulting in increased pain during physical activity and prolonged walking;
• Nocturnal soreness caused by venous blood pooling in bones;
• Obstructive pain is when the ankle gets stuck and the patient can neither bend nor straighten the leg because the pain increases significantly (obstruction occurs due to fragments of dead cartilage getting stuck between the joint surfaces);
• Meteorological Dependence – Pain can worsen when the weather changes, it gets colder, and the humidity in the air increases.

Ankle arthritis is a chronic process. Painful periods alternate with pain-free periods, indicating worsening of the condition. As osteoarthritis progresses, the time between relapses shortens, and at some stage the pain may become permanent.

Causes of ankle arthritis

On average, starting at age 30, the cartilage plates are progressively destroyed faster than new cartilage can be formed. Therefore, the prevalence of the disease increases with age. There are also certain gender characteristics. Therefore, women's joints are protected from damage until menopause. With the onset of the menopausal transition, the protective effect of estrogen gradually weakens, so that, starting from the age of 50, the incidence of pathology in men and women becomes even.The following causes of ankle arthritis have been identified, resulting in the resynthetic process of cartilage tissue not having time to override the catabolism (destruction) of cartilage:

• Suffering from traumatic injuries (jumping from heights poses particular danger);
• Previous joint inflammatory lesions;
• Ankle deformity, which may be related to flat feet, inversion or eversion of the foot;
• Inherited collagenopathies, particularly those affecting type 2 collagen synthesis;
• Ankle dysplasia;
• Being overweight increases the load on the ankle, causing the cartilage layer to "disappear";
• Menopause (the average age for women with ongoing menopause is 50-52 years);
• Metabolic disorders;
• Sedentary lifestyle;
• Previous orthopedic intervention in the joint;
• Recurrent hypothermia.

diagnosis

If you suspect osteoarthritis in your ankle, your doctor will recommend a plan of additional research. It may consist of the following methods:

• Ultrasound scan - This study allows you to assess the condition of the soft tissue structures of the joint (cartilage, bursae and surrounding tissues) and is the most informative method for early diagnosis of joint changes;
• X-ray - This method mainly evaluates the structure of bone tissue and helps to identify subchondral bone sclerosis, the presence of cysts in the subchondral area, and to visualize osteophytes (X-rays are used to detect the initial changes of osteoarthritis, mainly affecting the cartilage plate, especially the cartilage plate). difficulty).

In difficult clinical cases, computed tomography or magnetic resonance imaging can be used to obtain a detailed picture of the condition of the ankle joint. Each of these methods allows you to obtain a slice-by-slice scan (scan steps 2-3 mm) of the area under study and evaluate the condition of the intra- and extra-articular structures of the ankle joint.

Expert Opinion

Research shows that hormones are actively involved in the growth and differentiation processes of cartilage tissue. Chondrocytes have been identified to possess receptors for thyroid hormones, insulin, glucocorticoids, growth hormone, male and female sex steroids, and prolactin. Disturbance of endocrine regulation is considered an important causative factor, disrupting the balance between cartilage formation and destruction processes, leading to malnutrition and degeneration. Therefore, it is important to monitor the status of the endocrine-metabolic response in the body, perform screening examinations to assess the functional status of the thyroid gland, and contact an endocrinologist in the event of suspicious symptoms.

Ankle arthritis treatment

Treatment of arthropathy is carried out conservatively in the initial phase. Prompt treatment 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 severe destruction of the cartilage plates, accompanied by stiffness that interferes with human activities, the use of endoprostheses is required.

Conservative treatment

Conservative treatment of arthrosis begins with creating favorable conditions for joint function. Respected:

• Regular physical therapy exercises, swimming, and water aerobics are also helpful;
• Normalization of weight (if overweight);
• Use crutches or orthopedic canes during exacerbations;
• Wear comfortable orthopedic shoes.

To improve the condition of the cartilage plates, chondroprotectants are used, which are mainly injected into the joints. Hyaluronic acid and PRP therapy (plasma therapy) restore the condition of the cartilage plates. To relieve pain, symptomatic treatment is performed with nonsteroidal anti-inflammatory drugs.

Surgery

Ankle replacement is a rather complex task, so the surgeons of modern medical centers strictly adhere to modern surgical methods, which allow them to achieve optimal therapeutic results. Currently, the procedure uses only third-generation implants and requires only the removal of a small bone fragment. These prostheses stimulate osteoclasts (cells that form bone tissue) so they integrate well with the tibia, fibula and talus, ensuring special structural strength. The third generation prosthesis is unique in that it allows movement not only of the main joint, but also of the joint between the fibula and tibia, thereby evenly distributing the load on the joints.Surgical intervention for ankle replacement also involves correcting existing deformities and suturing damaged ligaments. This creates favorable conditions for maintaining the stability of the joint and fully ensuring its function.

Ankle prevention

Preventing ankle arthritis includes the following recommendations:

• Wear comfortable, pressure-free shoes and use orthotic insoles;
• engage in feasible physical activity;
• Special ankle braces are used when playing professional sports;
• Exclude jumping from high places;
• Correct accompanying lower limb deformities promptly.

recovery

After orthopedic intervention, temporary fixation of the operative joint was performed. The immobility period creates optimal conditions for bone tissue recovery and helps the implant to integrate most fully. After the cast is removed, health exercises, massage and physiotherapy are required under the supervision of a physiotherapist.

Questions and Answers

Which doctor treats ankle joints?

The disease is diagnosed and treated by an orthopedic traumatologist.

What is Arthrodesis?

Arthrodesis is a surgical option formerly used to treat the ankle joint. The surgery involves joint immobilization, which can negatively affect gait but can relieve pain. Therefore, endoprosthetic replacement is considered a more optimal and physiological option for surgical treatment of ankle osteoarthritis.

Can I participate in sports after ankle replacement surgery?

With third-generation implants, people can engage in "mild" sports - skiing, swimming, cycling and jogging. You should avoid high-intensity exercise - fast running, football, tennis, wrestling.