Deforming osteoarthritis is manifested by pain in the ankle joint, aggravated by walking. It is indicated by morning swelling and stiffness of movements, disappearing within an hour. In the conservative treatment of deforming osteoarthritis, drugs of various groups, massage and physiotherapeutic procedures are used. But with significant destruction of the cartilage and bone structures of the ankle, surgical intervention is necessary.
- General information about deforming arthrosis of the ankle joint
- Stages of pathology
- I degree
- II degree
- III degree
- Probable Causes of the Disease
- Signs and symptoms of the disease
- Methods of diagnosis
- How to treat DOA
- Orthopedic treatment
- Physiotherapeutic methods
- Therapeutic exercise
- Operative intervention
- Folk remedies and recipes
- Possible complications
General information about deforming arthrosis of the ankle joint
Deforming osteoarthrosis (DOA) of the ankle joint is a degenerative-dystrophic disease. Initially, it affects the cartilaginous layer lining the bone surfaces. Due to a lack of nutrients, cartilage does not retain moisture well, therefore it quickly becomes thinner, becomes dense, inelastic. Destruction of hyaline cartilage leads to increased stress on the bones when walking, flexing and extending the ankle joint. Bone plates are deformed with the formation of growths – osteophytes.
If a person does not go to the doctor for medical help, then DOA applies to healthy tissues. Ligaments, tendons, joint bags, muscles are gradually involved in the pathological process.
Stages of pathology
When determining the stage of DOA of the ankle, radiographic signs and main symptoms are taken into account. In most cases, the severity of clinical manifestations directly depends on the changes in bones and cartilage. But there are exceptions. Some patients complain to doctors of severe pain, although pronounced deformities of the ankle structures are not found in the obtained radiographic images.
Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.
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Osteoarthrosis of 1 severity may not clinically manifest. Occasionally, mild discomfort occurs after physical exertion or hypothermia, the mobility of the joint is somewhat limited. X-ray diagnostics can reveal a fuzzy narrowing of the joint space, the formation of single growths on the edges of bone surfaces.
A crunch appears at this stage of the DOA. Clicks, crackles accompany flexion and extension of the ankle, clearly audible when walking. Instead of slight discomfort, pain now occurs. They are aching, dull at rest and oppressive, strong when moving. Multiple osteophytes, signs of subchondral osteosclerosis in bone tissues are clearly visible on x-ray images. The joint gap is noticeably narrowed, so the ankle mobility is reduced.
For osteoarthrosis of a high degree of severity, pronounced deformation of the ankle joint is characteristic. Mobility in it is greatly limited due to the lack of joint space. At the 3 stages of DOA, extensive osteophytes are formed. With the displacement of bone growths, soft tissues are often injured, provoking the development of the inflammatory process. The formation of subchondral cysts, articular “mice” is also noted.
Probable Causes of the Disease
Primary DOA of the ankle develops with healthy cartilage. This usually happens due to the natural aging of the body, a slowdown in the rate of regenerative reactions, and a decrease in collagen production. The cause of secondary osteoarthritis is increased physical stress on the joint, for example, weight lifting, prolonged and frequent standing.
Pathological conditions already present in the body can provoke the development of the disease:
- injuries of the ankle – fractures, dislocations, damage to muscles and (or) ligament-tendon apparatus;
- congenital or acquired joint abnormalities;
- endocrine diseases, including hypo- and hyperthyroidism, diabetes mellitus;
- rheumatoid, reactive, infectious, psoriatic, gouty arthritis;
- systemic lupus erythematosus, scleroderma;
- pathologies, the course of which is accompanied by circulatory disorders in the legs (thrombophlebitis, chronic venous insufficiency);
- surgical operations on the ankle.
Predisposing factors include obesity, low physical activity, intense athletic training, deficiency of vitamins and minerals in the body, respiratory, intestinal, and urogenital infections.
Signs and symptoms of the disease
The development of osteoarthritis is indicated by the restriction of mobility. Stiffness of movements is especially felt immediately after awakening. It is accompanied by swelling of the ankle, a visible increase in its size compared to a healthy joint. It takes from 30 minutes to an hour to eliminate stiffness. Another leading symptom of ankle DOA is arthralgia. There are several types of joint pain:
- mechanical. The pain occurs during stress on the ankle, and disappears at rest. The cause of its appearance is microtrauma of bone tissue, venous congestion, muscle cramps, irritating effect of osteophytes;
- starting. Such pain does not last long. It occurs only at the very beginning of the movement due to swelling of the ankle or developed reactive synovitis;
- blockade. The formation of articular “mouse” is manifested by similar pain. A small area of the destroyed cartilage is restrained by bone surfaces. This leads not only to the occurrence of pain, but also blockade of the ankle joint.
The course of DOA is often complicated by synovitis – inflammation of the synovial membrane. A small rounded seal forms in the ankle region, and the skin above it turns red and becomes hot to the touch.
Methods of diagnosis
To determine the functional usefulness of the joint, a series of tests are performed. Their results make it possible to evaluate muscle strength, sensitivity, and preservation of tendon reflexes. The initial diagnosis can also be made on the basis of patient complaints, medical history, external examination. Since the symptoms of DOA of the ankle are similar to signs of arthritis, bursitis, tenosynovitis, instrumental studies are mandatory:
- magnetic resonance or computed tomography;
- ultrasound procedure.
According to indications, punctate is taken for morphological study. If necessary, an arthroscopic examination of the inner surface of the ankle, taking samples of synovial fluid and the membrane, cartilage tissue is prescribed.
How to treat DOA
Only complex therapy of deforming osteoarthrosis is effective. The main goals of treatment are elimination of symptoms, restoration of range of motion, prevention of the spread of the disease to healthy tissues. For this, pharmacological preparations are used, physiotherapy and physical therapy classes are carried out.
To eliminate pain in the treatment of DOA, non-steroidal anti-inflammatory drugs (NSAIDs) are used – Diclofenac, Nimesulide, Ketoprofen. With their ineffectiveness, drug blockades are used. Injection solutions of glucocorticosteroids (Diprospan, Triamcinolone) in combination with anesthetics (Lidocaine, Novocaine) are injected directly into the joint cavity or adjacent soft tissues. The following drugs may also be included in the treatment regimens for patients with ankle DOA:
- means for improving blood circulation – Trental, Eufillin, Xanthinol nicotinate;
- muscle relaxants to eliminate muscle spasms – Sirdalud, Baklosan, Midokalm;
- chondroprotectors for partial restoration of cartilage, strengthening ligaments – Arthra, Structum, Teraflex;
- preparations with B vitamins for improving tissue nutrition and transmission of nerve impulses – Milgamma, Combilipen, Neurobion.
From pain and swelling, ointments, gels with a warming, locally irritating, distracting effect are used. These are Finalgon, Kapsikam, Viprosal, Apizartron. But they are used only in the absence of acute inflammation in the ankle.
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With severe pain of the patient, wearing semi-rigid orthoses is prescribed. Such orthopedic devices securely fix the ankle due to metal or plastic inserts. Patients are shown compliance with the half-bed regimen, the exclusion of increased loads on the joint. During relapses, movement with a cane or crutches is recommended.
If the pains are mild or moderate, then they can be eliminated using elastic orthoses for the ankle. Products slightly limit mobility, soften the load on the joint. Well-warmed and soft bandages made of sheep or camel hair.
Physiotherapy is carried out both in the period of recurrence of DOA, and at the stage of stable remission. During exacerbations, several sessions of electrophoresis or ultraphonophoresis can reduce the severity of pain. For the procedures, glucocorticosteroids, analgin, novocaine, B vitamins, chondroprotectors are used.
During remission, patients are prescribed the following physiotherapeutic measures:
To improve blood circulation, applications with paraffin and ozokerite are used. Patients are recommended regular spa treatment with mud and mineral waters. In the treatment of deforming osteoarthritis, medical leeches and acupuncture are also used.
Massage procedures begin immediately after stopping severe pain. During the sessions, the main massage movements are performed – kneading, rubbing, vibration. Unlike manual therapy, the effect is only on soft tissues and muscles. This approach to the treatment of DOA allows you to strengthen skeletal muscle, while completely eliminating the load on the bones and cartilage. The following types of massage can be prescribed to the patient:
- point, or acupuncture;
- vacuum, or can.
Massage procedures are carried out not only for the treatment of DOA, but also for the prevention of its relapses. Restoring exacerbations for a long time helps restore optimal blood circulation in the ankle affected by osteoarthritis.
With DOA of the ankle of 1 severity, regular physical therapy exercises help to do without the use of drugs. And for patients with a more severe course of osteoarthritis, daily training can reduce the intensity of pain, swelling, and restore the usual range of motion. The high therapeutic effect of exercise therapy is due to the strengthening of the muscular corset of the ankle, the improvement of blood supply to tissues with nutrients.
What exercises can be performed at home:
- in a sitting position, alternately emphasize the feet first on their outer, and then the inner side surface;
- while lying down imitate riding a bicycle;
- in a standing position to do shallow lunges forward and backward.
Doctors of exercise therapy recommend to buy orthopedic rugs. Walking on them helps to eliminate stiffness of movements by accelerating blood circulation in the legs. In the warm season, barefoot walks on grass, sand, coarse and fine pebbles are useful.
Indications for surgical intervention are the ineffectiveness of conservative treatment, the rapidly progressive DOA of the ankle, and pronounced deformation of the bone surfaces.
Patients with grade 3 osteoarthrosis are immediately offered surgery. It is performed in 2 ways:
- arthroplasty. The destroyed bone structures are replaced with an artificial implant. Endoprosthesis service life is up to 15 years. Endoprosthetics allows the patient to return to an active lifestyle, including sports;
- arthrodesis. The tibia and talus are juxtaposed in a functionally advantageous position, and then fastened with metal structures. After 3-6 months, the joint is completely immobilized.
At the rehabilitation stage, patients are shown wearing orthopedic appliances, physical therapy and gymnastics classes, physiotherapeutic and massage procedures.
Folk remedies and recipes
With an exacerbation of the DOA of the ankle, folk remedies are ineffective. They are used only at the stage of remission to eliminate weak discomfort, swelling, stiffness of movements. Useful herbal teas from chamomile, lemon and peppermint, oregano, thyme. They have a calming and simultaneously tonic effect. From external means, ointments, alcohol rubbing are used.
|Folk remedies for the treatment of ankle DOA||Ways of preparation|
|Ointment||In a mortar, grind 20 g of lanolin with a tablespoon of Kalanchoe juice. Add 2 drops of essential oils of juniper, lavender, fir. Introduce in small portions 50 g of petroleum jelly and baby cream|
|Compress||Grind 10-15 large fresh leaves of dandelion to a state of gruel, add a tablespoon of thick honey. Put on the ankle, fix with a film, warm cloth, gauze bandage. Keep 1-2 hours|
|Herbal tea of chamomile, mint, oregano, thyme||Pour a teaspoon of dry plant material with a glass of boiling water. Insist 2 hours, strain, drink before going to bed bite with floral honey|
At the final stage of deforming osteoarthrosis of the ankle, complete or partial immobilization of the joint is observed. If it occurs in a functionally disadvantaged position, then a person is able to move only with the help of crutches, since emphasis on the foot is impossible.
The course of DOA is often complicated by secondary reactive synovitis, spontaneous hemorrhages in the joint cavity.
Prevention of DOA is the elimination of all factors that provoke damage to the cartilaginous structures of the ankle. Orthopedists recommend quitting smoking and alcohol, which worsen the state of the blood vessels of the legs. It is necessary to replenish the diet with fresh vegetables, fruits, low-fat sour-milk products – the main sources of water and fat-soluble vitamins, trace elements. During sports training, elastic bandages should be used to protect all joint structures from microtrauma.