Ankle arthropathy is a degenerative, dystrophic disease of the structures of the musculoskeletal system. It affects the lower extremity. It is considered one of the most common forms of joints: it accounts for up to 30% of all cases of degenerative-dystrophic joint damage. The pathological process occurs not only in elderly patients. About a quarter of patients are under the age of 40.
The disorder is accompanied by persistent pain and a gradual decrease in joint and lower limb function. Without treatment it progresses and does not go away on its own. Diagnosis and treatment of the disorder is the work of an orthopedic doctor (depending on the cause, a traumatologist is involved, as well as physiotherapists and physical therapists).
Causes of ankle arthropathy
Osteoarthritis is considered a multi-etiological disease. Its development occurs as a result of the influence of a group of causes. With age, the number of disease-causing factors increases, hence the increased likelihood of a pathological process. But not everything is so simple.
Pathogenesis of the disorder
There are a group of causes of ankle arthrosis, among the most common:
- unreasonable physical activity;
- injuries?
- operations;
- metabolic diseases;
- uncomfortable shoes;
- other diseases of the musculoskeletal system.
- rheumatic diseases.
Irrational stress can be a result of lifestyle or a consequence of career choice. Continuous walking, standing in one place, carrying heavy objects, vigorous activity. All of these are provocateurs of the pathological process in the medium term (several years).
Another reason is injuries, especially intra-articular fractures, dislocations, but also severe bruises (to a lesser extent). Arthropathy of the ankle joint manifests itself imperceptibly, but it constantly progresses. Often patients underestimate the consequences of the trauma they have suffered.
Surgeries can cause arthropathy. However, such a complication is relatively rare. Mainly due to incorrect assessment of the clinical situation. insufficient qualifications of the doctor.
Metabolic pathologies, such as diabetes mellitus, can cause a disorder. However, much more often the causes of ankle arthropathy are gout, as well as hormonal disorders (for example, during menopause).
Uncomfortable shoes are one of the main factors in the development of the pathological process. The disorder develops due to improper distribution of the load on the leg. Complex disorders usually develop: not only joints, but also spinal injuries. At least - osteochondrosis. But more dangerous problems are also possible.
Dysfunctions of the musculoskeletal system themselves also increase the likelihood of a pathological process. Intervertebral hernias, osteochondrosis, and congenital disorders pose additional risks.
Rheumatic diseases are represented by arthritis, systemic lupus erythematosus. Lesions of a degenerative-dystrophic nature are secondary, but they aggravate the underlying disease and worsen the prognosis.
Ankle arthropathy is a multifactorial disease. As a rule, it develops under the influence of several causes at the same time. There are exceptions, but they are rare. Also, the number of factors affects the severity of the disease and the rate of progression of the pathological process.
The development of the pathological process is gradual. In the initial stage, the local blood circulation and the distribution of the dynamic load on the leg are disturbed. Gradually, destructive processes are added to the cartilage. Subdued inflammation begins. Degeneration of other structures of the ankle occurs: capsule, ligaments, bones, etc. The more advanced the disease, the more difficult the treatment. It requires more effort and time.
Factors of increased risk of developing arthropathy
Dystrophic destruction of the tissues of the ankle joint occurs not only as a result of the influence of direct causes. The severity, likelihood of the disease and the nature of its course are influenced by risk factors. They complete the offense picture. Between them:
- do you usually wear heels?
- the physically demanding nature of the work (including professions with invisible risks: teachers, cooks also get sick);
- previous injuries to the ankle joint (there are cases where the disorder manifested itself years after the injury);
- history of endocrine diseases (hormonal disorders create additional risks);
- history of musculoskeletal disorders.
- age 40+ (although the disease also occurs in younger people).
- increased body weight;
- gender (women suffer more often than men);
Ankle arthropathy is a slowly developing disease; symptoms are not immediately apparent. Therefore, it is difficult to assess which risk factors and causes cause the pathological process. It is necessary to collect a complete medical history.
Classification and types of damage to the ankle joint
The pathology is classified according to two bases.
The first criterion is the origin of the pathological process. Climax:
- post-traumatic form of the disorder (develops after injuries to the ankle joint or other structures of the musculoskeletal system).
- deforming arthropathy of the ankle joint: consequence of metabolic disorders or injuries, accompanied by slow but constant deformation of the joint.
- Metabolic arthropathy develops against a background of diabetes, hormonal disorders or gout (disorders of purine metabolism).
The second basis of classification is based on the staging of the pathological process. In its development, arthropathy of the ankle joint goes through the following stages:
- initial or early;
- progressive;
- advanced arthropathy.
In the first stage there is no clinical picture as such or it appears after intense physical activity. The pathological process is detected only with the help of special diagnostic methods.
The progressive phase of the disorder is accompanied by an intensification of the clinic. Symptoms appear after mild physical activity. Load tolerance decreases. There is a constant pain syndrome, as well as limited mobility of the foot in the ankle joint.
The final phase of the pathological process is accompanied by severe pain, as well as other symptoms in a state of complete rest. Both supportive and motor functions are impaired. Often a person becomes disabled. Complex surgical treatment is required, including endoprosthetic.
Great!
Staging plays a major role in determining treatment strategies and predicting disease course and outcome. The disorder is best treated at an early stage. The more advanced the pathology, the more difficult and time-consuming the correction.
Symptoms of the disorder
The clinical picture depends on the form and stage of the pathological process. Typical events are:
- pain;
- fatigue;
- Inability to exercise?
- swelling;
- disorders of the supporting function of the foot.
- muscular weakness.
Pain in the leg is initially observed only after intense physical activity. Then a little activity is enough. In the advanced stage of the pathological process, pain is always present, regardless of the load.
Fatigue is observed from the very first stage of the disorder. The feeling of muscle weakness and increased fatigue develops along with the disease. Signs indicate further development of the disorder.
Exercise tolerance also gradually decreases. In the severe stage of the disorder, a person cannot climb to the second or third floor. We have to make stops.
Swelling is a sign that is always there. The foot at the ankle appears swollen and enlarged. This is a non-special event.
The initial pain is characteristic. After a long stay in one place, severe stiffness of the joint develops. The first movements cause great discomfort. The pain and discomfort gradually disappear as the person continues to move.
The clinical picture depends on the degree of articulation of the ankle joint. It plays a large role in determining the stage and severity of the pathological process. The doctor systematizes the symptoms through a process of verbal questioning and history taking.
The disease is characterized by a chronic course. During periods of exacerbation, signs of articulation of the ankle joint appear more clearly. In the chronic phase, remission is only partial. The clinic is not so bright, but the symptoms do not go away completely. Then a new exacerbation of arthropathy of the ankle joint occurs, the manifestations again become intense. And so on in a cycle until quality healing takes place.
Complications of ankle arthropathy
Complications of the pathological process are related to maintaining the ability to work and the ability to care for oneself.
Patients present with ankle deformities. The pathological process ends with the formation of contractures, areas of primary or complete immobility of the limb in the ankle. The condition can only be corrected surgically.
At the time of exacerbation, the development of arthritis and inflammation of the synovial bursa is characteristic. This condition lasts for several weeks and during its acute course completely eliminates the ability to work and move.
The final result of the pathological process is the reduction and then the complete loss of the supporting function of the leg; the person cannot move normally. You must use crutches. There is a complete loss of the ability to work, and in some cases, the ability to care for oneself. In advanced stages of ankle arthropathy, patients become disabled.
Diagnosis of the disease
The diagnosis of damage to joint structures and cartilage tissue is carried out under the supervision of an orthopedic traumatologist. The exams are typical. It is not difficult to identify the pathological process, as well as its degree of severity. Among the techniques:
- verbal questioning of the patient to better understand the nature of symptoms and health complaints;
- collection of memories, which allows you to determine the possible origin of the pathological condition.
- palpation: arthropathy is indicated by deformity, swelling, pain during passive movements.
- X-ray of the ankle: a routine examination that provides sufficient information to diagnose and determine its severity, is considered the gold standard.
- MRI if radiographic data are insufficient.
Other studies may be conducted. For example, computed tomography (arthropathy affects not only the cartilage, but also the bones; CT allows detailed, accurate imaging of the nature of the disorders).
Note!
Arthropathy does not have specific manifestations, especially at an early stage. Therefore, on your own, without sufficient knowledge, it will not be possible to distinguish pathological processes from each other. Special diagnostic tools are required.
Laboratory diagnostic techniques provide little data. They are only informative in terms of identifying the inflammatory process and help to diagnose certain forms of joints (metabolic origin, rheumatoid nature).
Treatment methods
The treatment of arthropathy of the ankle joint is carried out by conservative and surgical techniques. The best results can be achieved if you resort to complex correction.
Conservative treatment includes the use of medication, exercise therapy and massage therapy. The following drugs are used:
- local anti-inflammatory;
- general anti-inflammatory drugs (in the form of tablets or injectable solutions);
- chondroprotectors;
- nicotinic acid and other means to improve metabolic processes.
Exercise and physical therapy, along with massage, are aimed at recovery after the acute condition has resolved. These methods are important during the recession period. If the disease occurs in an acute form with severe clinical symptoms, the methods are postponed.
Surgical treatment is required for deformities and persistent deviations in joint anatomy. Plastic surgery or endoprosthetic joint replacement, replacing the joint with an artificial analogue, is possible. This is a high-tech correction method.
Predictions
The prognosis depends on the time of treatment, the state of health, the cause of the joint, as well as the degree of development of the disorder. The more advanced the disease, the more complicated the situation. If treatment is started early, the prospects for cure and full recovery are good. In other cases, surgery and a long recovery period are required.
Prevention of the disorder
Prevention of ankle arthrosis includes:
- wearing comfortable shoes;
- early treatment of musculoskeletal diseases.
- reasonable welfare control;
- weight control;
- avoid injury;
- load control.
Prevention can reduce the risk of ankle arthropathy by 2-3 times. The probability of a pathological process will be minimal.