The ankle joint is often injured due to the heavy load it is subjected to. Such a diagnosis as osteoarthritis of the ankle is not uncommon. It is placed regardless of the age and sex of the patient. What is ankle osteoarthritis and how can it be treated?
What is?
There is a huge load on the ankle. Its function is to keep the body upright. Thanks to him, one walks and runs. When the ankle system is disturbed, it is extremely difficult to lead a familiar lifestyle. What disrupts the work of the ankle?
Osteoarthritis of the ankle, what is it? It is a chronic disease of the joints, which is characterized by a degenerative course. Irreversible processes are triggered in the cartilage of the joint, which lead to terrible complications.
Osteoarthritis of the ankle develops gradually. Healthy joint surfaces are elastic and smooth. They provide cushioning under heavy loads and smooth gliding while driving. In pathology, tissue trophism and metabolism are impaired. The surface of the joint becomes inelastic and rough. During movement, the cartilage comes into contact with each other, which leads to inflammation. When lifting weights, the main load falls on the bone, which threatens with degenerative disorders.
Lack of treatment leads to more serious disorders. Damage to cartilage and tissues is observed in 3-4 stages. The synovium becomes inflamed. The joint becomes unstable. The support function is broken. All these disorders generally lead to the fact that movement becomes impossible.
Osteoarthritis (osteoarthritis) is one of the most common joint diseases, affecting a large number of people.
Causes and risk factors
What is osteoarthritis of the ankle joint, we understood. Now let's find out what its main reason is. Osteoarthritis of the ankle is considered a pathology in old age. This is due to age-related changes in the body. The cartilage becomes thinner, the bones become unstable and fragile. However, in the last decade, the diagnosis of ankle osteoarthritis has become much younger. Such statistics are disappointing, as many patients ignore the first signs of the disease. Late diagnosis always threatens the development of serious complications.
Provoking factors include:
- dislocations;
- bruises;
- inflammatory diseases;
- injury;
- Overweight;
- impaired metabolism;
- unbearable physical activity;
- wearing uncomfortable shoes;
- autoimmune and endocrine diseases;
- osteochondrosis.
Clinical symptoms
Osteoarthritis of the ankle is recognized by the following characteristics:
- Pain. It is mild at first and manifests itself after walking or exercise. Sometimes when a person is in an awkward position. As the pathological process progresses, the pain syndrome intensifies and worries at rest.
- Swelling and inflammation. These signs appear against the background of injuries and dislocations. The body temperature in the affected area rises.
- Click. When the ankle is affected, the click is "dry" and causes an attack of pain.
- Dislocation or subluxation. Due to thinning and degradation of cartilage tissue, the joint becomes unstable. The bones may shift and fall off the joint capsule. These changes cause attacks of acute pain.
- Stiffness of the joints. When cartilage tissue is replaced, the bone joint ceases to function normally, which negatively affects its mobility.
- Deformation of the joints. The symptom appears in 3-4 stages of osteoarthritis. Osteophytes also cause ankle curvature.
If any of the symptoms occur, it is recommended that you see a doctor immediately. Timely treatment is a step towards recovery.
Osteoarthritis of the joints of the foot and ankle is characterized by a slow progression with the gradual development of clinical manifestations over several years.
Classification and stages
The disease develops in different ways. In some patients, several years pass from the first signs to the final stage, in others the rapid development of the disease is observed. The speed depends on the age and health of the patient, the time of starting therapy. The symptoms of osteoarthritis of the ankle joint become more pronounced as the disease progresses.
There are four stages of osteoarthritis:
- The first stage is often unnoticed. Sometimes morning stiffness and ankle pain appear after a heavy load. When the foot moves, a characteristic crunch is heard. The pathological changes are not yet visible on X-rays, but the destructive process of cartilage has already begun.
- Morning stiffness lengthens. The development of the legs takes 20-30 minutes. Sometimes lameness appears. Osteoarthritis of the 2nd degree of the ankle joint is recognized on the radiograph by the growth of bone tissue, bone displacement.
- The symptoms of 3 stages are pronounced. The pain worries not only after a heavy load, but also at rest. It is difficult for the patient without painkillers. The lameness increases. Crutches may be needed. The affected joint is swollen and deformed. The muscles of the ankle atrophy. X-ray examination shows narrowing of the joint space, formation of osteophytes, subluxation.
- Stage 4 is the most difficult. It develops as a result of lack of treatment. The cartilage is destroyed, the surfaces of the joints are fused. Walking is no longer possible.
With the development of osteoarthritis of the ankle there is a gradual change in the cartilage and bone tissue of the joint surfaces.
Diagnosis
The diagnosis of ankle osteoarthritis is based on clinical symptoms and information obtained during examinations. Laboratory tests are considered ineffective because there are no special tests to detect pathology. During the period of remission all indicators are within normal limits, in case of exacerbation of the disease a clinical blood test will show a high level of C-reactive protein and ESR. These indicators indicate that the pathological process has already begun.
Instrumental methods are used to confirm the diagnosis:
- radiography;
- Magnetic resonance;
- Ultrasound;
- bone scintigraphy;
- diagnostic puncture of the joint.
Ordinary radiography
Simple radiography is the most reliable and effective method for diagnosing diseases of the musculoskeletal system. The principle of manipulation is a different absorption of X-rays from muscle tissue. Soft tissues allow the passage of X-rays, but hard tissues absorb. X-ray examination allows you to diagnose both the disease itself and its consequences.
Conventional radiography is a method of examination in which a small amount of X-rays are transmitted through the body or part of the human body.
The photo allows you to see:
- The condition of the bone surfaces in the articulation.
- The shape, size and location of the structures in the joint are relative to each other.
- The condition of the tissue.
- The size of the joint space.
These indicators help the doctor determine the type and extent of joint damage. If the data are not enough, then doctors prescribe other tests.
In osteoarthritis of the ankle, an X-ray is taken in three projections:
- country;
- back;
- back with the foot moved inwards.
The disease is characterized by the following changes:
- reduction of joint space;
- the presence of osteophytes;
- bone cartilage replacement (subchondral sclerosis);
- insignificant cavities in the periarticular part.
Nuclear magnetic resonance
Nuclear magnetic resonance imaging (MRI) as a diagnostic method allows you to examine those parts of the body where there is water. The image shows bones in a dark color because they contain less water, but muscle tissue, discs and nerves appear lighter. MRI allows you to detect the smallest changes in the structure of bone tissue and joints. The test is also prescribed to patients before prosthetic joints. YMG has a drawback - high price.
In nuclear magnetic resonance, a change in the properties of hydrogen molecules is recorded under the influence of a strong magnetic field.
Magnetic resonance
Magnetic resonance imaging (MRI) is an alternative diagnostic method that allows you to carefully examine the ligament structure of joint, muscle and cartilage tissue. With the help of MRI, the doctor assesses the condition of the joints of the lower leg. Based on the data from the study, the pathology is revealed at an early stage of development.
The diagnostic principle is based on exposure to radio waves and strong magnetic radiation. The magnetic field used is not dangerous and does not pose a health hazard.
MRI is contraindicated in mental disorders, during pregnancy and in the presence of metal objects in the human body.
When diagnosing osteoarthritis of the ankle, classic (closed type) MRI devices are used, as they have better image quality. The magnetic resonance machine is a large cylindrical tube with a magnet around it. The patient lies on a special table. The ankle is fixed with a special coil. The procedure takes 30-40 minutes. The examination is absolutely painless. Patients may feel warmth in the lower leg.
Ultrasound
Ultrasound has been widely used in medicine since the 1990s. This technique has proven itself well in making accurate diagnoses. An ultrasound scan for osteoarthritis of the ankle is also performed.
Today, ultrasound is not very important in the diagnosis of osteoarthritis, as it does not allow a good enough examination of damaged joints.
The device with which the study is conducted produces waves at ultrafrequencies. The waves are reflected by the tissues and recorded on the monitor. Based on the obtained image, the doctor determines the type of pathology. A special gel is used to make the monitor image clear. It eliminates air gaps and gives the sensor better glide.
The ultrasound examination does not harm the patient, so the procedure can be repeated many times. The advantages of ultrasound also include low cost and high accuracy.
The following indicators are a clear sign of osteoarthritis:
- cartilage thinning;
- the presence of bone growths;
- accumulation of effusion in the joint cavity (synovitis);
- loss of cartilage space.
Bone scintigraphy
Scintigraphy is a high-precision examination that, using isotopes, is able to detect pathological changes in the bones. Doctors divide pathogenic foci into "cold" and "hot". In the first case we are talking about areas where there are no isotopes. These areas are poorly supplied with blood and they are not visible during the scan. "Cold" areas are places that are affected by malignant tumors. In "hot" areas, isotopes accumulate rapidly and appear very bright when scanned. Such areas indicate the presence of inflammatory processes.
The role of scintigraphy in osteoarthritis is significant. The study helps to distinguish osteoarthritis from a number of other diseases when the clinical symptoms are extremely similar.
During the scintigraphy of the bones, a special preparation containing special labeled atoms is injected into the body.
Based on the results of the scintigraphy, the doctor makes a clinical prognosis and determines the treatment regimen. The only disadvantage of the study is its high cost. Scintigraphy is performed with the help of special equipment and unfortunately not all medical institutions can afford to buy it.
Although radioactive scanning is a safe procedure, it still has a number of contraindications:
- pregnancy;
- breastfeeding period;
- taking barium-containing drugs.
When a radioactive substance is injected, some patients experience an allergic reaction in the form of itching and rash. These side effects do not cause dangers and disappear on their own in a short time.
Joint puncture
A joint puncture is a diagnostic procedure in which a needle is inserted into the joint cavity to collect synovial fluid. This fluid is then sent for further testing. Based on the data obtained, the doctor makes a conclusion about the nature of the disease and the stage of its development.
At first glance, the puncture is a simple procedure, but it is not. Withdrawal of fluid from the joint capsule requires extreme precision of the doctor's movements. The synovium is very thin and an awkward movement traumatizes it. As a result, an inflammatory process develops. Potential risks include infection. It is not difficult to get the infection into the joint capsule with poorly sterilized instruments.
The technique of manipulation is different for each joint. When collecting the exudate from the ankle, the puncture is made in front, between the outer ankle and the tendon of the extensor digitorum longus.
Diagnostic sampling of intra-articular fluid allows laboratory analysis and excludes inflammatory arthritis.
Basic principles of treatment
Once the diagnosis of ankle osteoarthritis is confirmed, the symptoms will not be delayed. Treatment begins immediately. Further prognosis depends on the well-chosen treatment regimen and the timeliness of onset.
Osteoarthritis is an insidious disease. It cannot be completely cured. The goal of therapy is to stop degenerative processes and prolong the period of remission. For this purpose, doctors prescribe medication, physiotherapy, massage, therapeutic gymnastics and folk remedies. If all conditions are met, it is possible to rely on positive dynamics, otherwise the disease progresses.
Drug therapy for osteoarthritis
Depending on the therapeutic effect, drugs are divided into several groups:
- Anti-inflammatory or analgesic. This group of drugs is aimed at eliminating the source of inflammation and relieving pain. The earlier anti-inflammatory therapy is started, the better the chances of saving the joint. Drugs from this group can be produced in the form of tablets and ointments.
- Glucocorticoids. These drugs are prescribed when the above remedies are ineffective. They are produced in the form of a solution for injection. The drug is injected directly into the joint.
- Chondroprotectors. Designed to slow down the destruction of cartilage.
The treatment regimen and dosage are chosen by the physician based on the severity of the symptoms, the age of the patient, the presence of comorbidities, and other factors. Self-medication is dangerous and often worsens the situation, as many drugs have a number of side effects and have their own contraindications.
Characteristics of radical treatment
If conservative therapy is unsuccessful, then doctors are forced to resort to a radical method of treatment (surgery). The operation is also displayed when:
- secondary (post-traumatic) and primary arthrosis of 3-4 degrees;
- osteoarthritis with complications;
- constant and severe pain in the ankle, radiating to the knee;
- severe lameness;
- paresis and paralysis of the muscles of the legs;
- violation of the flexion-extensor function of the joint;
- violation of the supporting ability of the foot.
Surgery is contraindicated if:
- the patient is under 12 years of age;
- fistulas are found in the joint;
- the patient has a history of diabetes mellitus, heart failure;
- Infectious diseases have been detected in the area of the proposed intervention.
Traditional treatment
Doctors believe that the treatment of osteoarthritis should be carried out exclusively under the supervision of a specialist, but they do not deny the positive effect of folk remedies. Alternative medicine acts as an effective prophylaxis that helps eliminate symptoms and maintain remission.
Folk remedies are rather symptomatic treatment for osteoarthritis of the foot.
Home treatment should be agreed with your doctor to avoid side effects and complications.
Traditional healers offer treatment for ankle osteoarthritis with:
- Burdock. Wash burdock leaves with soap and running water. Apply the leaves with the soft side on your skin. Secure the top with a bandage or stretch film. It is better to keep the compress overnight.
- Sea salt. Cut the salt in a pan. Pour it into a linen bag and attach it to your ankle. Hold the bag until the salt has cooled. The heat relieves the pain. Instead of salt, sand, lentils and buckwheat are also used.
- Lilac. Pour the triple cologne over the lilac flowers. Leave the tincture in a dark and cool place for 10-14 days. Rub the affected area in the morning and evening.
- Eggshells. Grind the shells in a coffee grinder. Take the resulting powder for ½ teaspoon. before eating.
Remember that folk remedies should not be the only measure. The complex treatment includes medication, exercise therapy, massage, physiotherapy, balneotherapy. In advanced cases, doctors resort to radical measures - surgery.
Surgery
In osteoarthritis of the foot, the following types of operations are used in medicine:
- arthrodesis of the joint;
- arthroscopy of the joint;
- endoprosthesis.
Arthrodesis is an operation to immobilize a joint. It is performed in order to restore the limb to the lost ability to support. The only disadvantage of the operation is that the bones (shin and talus) grow together, which leads to immobilization. Arthrodesis is rarely used in medical practice.
Arthroscopy is a minimally invasive procedure. During the operation, the doctor makes small incisions in the joint area and inserts an arthroscope through them (a special tube at the end of which a camera is installed). With its help, the surgeon carefully examines and assesses the condition of the intra-articular structures. If necessary, parts of the damaged joint or blood clots are removed from the synovial fluid. This manipulation is less traumatic. The only disadvantage of arthroscopy is that the risk of recurrence is too high.
Endoprosthesis is an extreme treatment. It is performed with advanced osteoarthritis. Endoprosthesis allows you to replace the affected joint partially or completely. Innovative prostheses with modernized mechanics are used as a prosthetic product. The artificial joint lasts from 10 to 20 years.
Power supply characteristics
To achieve a favorable result, drug treatment is supplemented with dietary therapy. Nutritionists have developed a special diet to avoid exacerbation of the disease and at the same time provide the body with all the necessary vitamins and nutrients. Diet for overweight patients plays a special role. Because obesity is one of the causes of osteoarthritis, weight correction is an integral part of treatment.
The patient must reconsider a number of their daily habits that contribute to and provoke the progression of osteoarthritis of the foot.
Nutritionists recommend that you adhere to the following dietary conditions:
- Eat often and in small portions.
- Drink at least 2 liters of fluid a day.
- Give up jam and salt.
- The last meal is no later than 18. 00.
- Dishes are allowed steamed, cooked or baked.
The main task of the diet for osteoarthritis is a balanced and enriched diet. The post cannot be turned off. Heavy diets and body cleansing do more harm than good. Calcium is expelled from the body, which is needed to repair cartilage. A nutritionist will help you put together a daily diet.
In osteoarthritis it is allowed to eat cereals, pasta, dairy products, cheese, legumes, vegetables, fruits, rye bread, dried fruits, nuts, fish, poultry. Heavy and greasy side dishes, foods containing dyes and flavors, as well as pickles, marinades, smoked meats, fatty broths, baked goods, spices, sauces, chocolate, ice cream, coffee and alcohol are prohibited.
Prevention of osteoarthritis
To avoid the development of osteoarthritis of the ankle joint, doctors recommend that preventive measures be taken:
- wear comfortable shoes without heels;
- follow a diet and drink plenty of fluids;
- seasonally take vitamin and mineral complexes;
- swimming;
- walk more in the fresh air;
- elimination of excessive stress on the legs;
- avoid hypothermia;
- be examined by a doctor in a timely manner.
With existing osteoarthritis, it is recommended to adjust the lifestyle:
- Give up bad habits. They have been shown to provoke blood stasis in the tissues and accelerate the destruction of cartilage.
- Perform a set of exercises to warm the ankle.
Forecast
Osteoarthritis is a progressive disease. Without treatment it leads to irreversible consequences and complete immobilization of the joint. Early diagnosis of the pathology allows you to do without radical measures. Medications are able to stop the pathological process and alleviate the patient's condition. The fight against the disease in the early stages is without complications.