Inflammation of the ankle joint – causes and treatment of the disease

Arthritis of the ankle joint is the result of an injury, infection or a sign of the progression of an autoimmune disease. Pathology occurs with equal probability in men and women. Violation is subject to the elderly and the elderly, athletes who often expose themselves to damage. Only at the doctor’s appointment it is confirmed that the deterioration of health caused inflammation of the ankle joint – the reasons and treatment are also determined by a specialist, since the patient himself can only speculate about the primary source of the disease. The main argument of an early visit to the hospital is improvement of well-being, prevention of disability, the risk of which is quite high with the disease in question.

Causes of inflammation

How to treat inflammation of the ankle joint, and completely depends on the factor that served as the root cause of the disease.

The following phenomena predispose to the development of pathology:

  1. Past injuries, especially if they were complicated by a bacterial infection. Even long-standing injuries can serve as a beneficial condition for the development of an active inflammatory process. Since dislocations, punctures, fractures are accompanied by a violation of the production of synovia, which causes arthritis.
  2. Transfer of bacterial microflora from nearby foci – for example, if the patient has cystitis, boils, prostatitis, pyelonephritis. Bacterial flora reaches the joints and potentiates inflammation in their cavity.
  3. Subcooling – general or local (when a person puts on light shoes in the cold season, he does not warm his legs enough).
  4. Autoimmune diseases – systemic lupus erythematosus, rheumato >

Frequent exertion contributes to the development of inflammation in the ankle. For example, if by occupation you need to stand, walk, and lift weights for a long time. Interaction with a large weight also involves an increase in the load on the ankle.

Symptoms

Inflammation of the ankle joint is a disease that cannot be overlooked. Unlike latent pathologies, arthritis of this part of the leg is discomfort. An unpleasant sensation increases daily (with an acute form of pathology) or responds to a change in weather (with prolonged inflammation).

The disease is characterized by the following symptoms:

  • pain syndrome. The pain becomes more intense as inflammation progresses due to the circulation of the bacterial flora;
  • edema. An increase in the volume of the leg creates a problem with the selection of shoes;
  • increase in body temperature (local hyperthermia);
  • impaired functional ability. It is painful for the patient to step on his leg; he is limping. When arthritis begins, pain occurs when the foot is placed on the surface. A sharp backache occurs in the heel, a painful sensation covers the lower leg completely, extends to the knee. The patient is forced to stay in a sitting position to make him feel better.

Various sounds are clearly heard: by putting an ear to a sore joint, you can recognize a specific crunch, clicks, a feeling of friction or creaks in the leg at the site of inflammation.

Diagnostics

If arthritis is suspected, the following diagnostic measures are performed:

    Puncture of the joint with the evacuation of synovial flu >

When studying wound discharge in patients suffering from purulent inflammation of the ankle joint, it is possible to isolate gram-positive pathogens – Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus saprophyticus, Enterococcus faecalis. In gram-negative pathogenic microflora, Pseudomonas aeruginosa, Escherichia coli are isolated. The information obtained from bacteriological studies is of informative value. The doctor will determine the severity of the clinical course of purulent arthritis of the ankle, prescribe an adequate treatment.

Survey and survey data are taken into account. The specialist finds out if there were any cases of ankle joint inflammation in the patient’s family, he learns about the events that preceded the disease (injuries, hypothermia).

Treatment of ankle inflammation

Conservative treatment is carried out at stages 1 and 2 of the development of arthritis of the ankle joint. If at the time of seeking medical help the patient has already 3 or 4 stages of pathology, the question of surgical intervention is considered. Attempts to treat the disease with medication alone are equivalent to a loss of time, which is fraught with amputation of the patient’s inflamed limb.

With a persistent increase in body temperature, systemic antibiotic therapy is prescribed. Having received the results of the performed sowing, it is permissible to carry out its correction taking into account the sensitivity of the pathogenic flora identified in the sample of biological material.

Shishkevich Vladimir, orthopedic and traumatologistShishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.

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Medication

The doctor’s task is to stop the inflammatory process in order to restore the functional ability of the affected leg. But it is important to normalize overall well-being. For this purpose, systemic administration of painkillers is prescribed.

Drug therapy involves the following drug prescriptions:

  1. Nonsteroidal anti-inflammatory drugs (NSAIDs). Diclofenac, Nimesulide (Nise), Ibuprofen provide a reduction in the spectrum of the inflammatory process, relieve pain.
  2. Analgesics. Assign when the administration of NSAIDs is not enough to reduce pain. Ketanov, Ketarol, Dexalgin, Analgin – these drugs stop the attacks of pain, help postpone the recovery.
  3. Therapy aimed at reducing edema. To remove puffiness, diuretics are prescribed – Furosemide, Lasix. Dosage is determined by the weight of the patient, the severity of edema.
  4. Vitamin Therapy. The introduction of vitamins is necessary to improve blood circulation, strengthen the immune properties of the patient’s body during postoperative rehabilitation.
  5. Hyaluronic acid is part of the treatment of ankle inflammation. The natural component helps increase the viscosity of the synovial fluid.
  6. Antibiotics are prescribed if it is laboratory proven that the cause of the inflammation is the introduction of the bacterial flora into the joint.

An important part of the treatment of this pathology is intra-articular administration of drugs. More often – hormonal. Systemic administration of corticosteroids causes a wide range of adverse events. This type of hormone therapy in 8 out of 10 cases does not provide sufficient inhibition of the intensity of the inflammatory process.

Local administration of drugs enhances the degree of influence on the center of the inflammatory process, reduces the need for systemic therapy, minimizes the risks of adverse outcomes.

Glucocorticoids are injected into the joint with the following provoking factors: when practicing basic therapy by a specialist; with exacerbation of protracted arthritis (simultaneously with the basic and generally successful treatment); if basic treatment is not possible for various reasons. But the main reason for the introduction of glucocorticoids into the joint is its inflammation, which proceeds in the active phase.

Hormonal drugs for administration:

    Triamsinolone aceton >

The dosage of the drug (single, daily, course) is determined by the size of the affected joint. If the doctor prescribes Kenalog or Metipred, the dose is 20 mg (as for the shoulder, elbow joints). It is impractical and unsafe to administer a large dosage (by the way, 40 mg is used to eliminate arthritis of the knee joint – it is considered physiologically large).

Features of local hormone therapy are as follows:

    often repeated injections of large doses of glucocortico >

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In addition to hormones, the drug gentamicin is also injected into the joint – at the rate of 8 mg of antibiotic in 0,5 ml of a 0,25% solution of novocaine. Preliminary evacuation of synovial fluid is impractical. According to the results of observations, the drug gentamicin, introduced into the joint cavity, already on the 2nd day gives a pronounced improvement in 28 patients out of 30 taken under observation. There was a complete regression of hyperemia, managed to stop night pain; the effusion in the joints decreased by 3 times. The medicine removed soft tissue swelling.

99% of patients rated the obtained effect as expressed, which corresponded to objective data. In case of confirmation of acute arthritis of the ankle joint, 1 intracavitary injection of gentamicin was sufficient. Thanks to a single injection, a complete reverse development of the signs of the inflammatory process occurred.

Physiotherapy

Physiotherapeutic methods help to recover patients with inflammation of the ankle joints of the initial stages, accelerate recovery in operated patients.

The following types of physiotherapeutic treatment are relevant:

  1. Ultrasound. Mechanical vibrations have a high therapeutic ability. The positive effect is based on the provision of micromassage of cells and tissues. Ultrasound promotes reflex expansion of blood vessels, which causes an increase in blood supply to tissues. The intensity and quality of biochemical reactions increase. Since the permeability of cell membranes is normalized, diffusion and adsorption processes are activated, circulation and distribution of lymph, blood flow are improved. Simultaneously with the above processes, repair and regeneration are accelerated. Doctors regulate and enhance the therapeutic properties of ultrasound by adding medical ointments, gels. Despite the w />

The table reflects the main criteria for observing patients who underwent phonophoresis with each of the drugs:

Evaluation criterionPhonophoresis with Fastum® GelPhonophoresis with Lyoton® Gel
The duration of the drug10 days (Regarding acute arthritis of the ankle joint)10 days (Regarding the treatment of ankle arthritis in the acute phase)
The main active component, the action provided by itThe main active ingredient of the drug is ketoprofen, a non-steroidal anti-inflammatory compound that reduces the inflammation process – intra-articular, in muscles and tendonsThe active component is sodium heparin. When used externally, it has the following positive effects:
  • gradual antithrombotic;
  • antiexudative;
  • moderate anti-inflammatory.

It stops the formation of thrombin, suppresses the physiological activity of hyaluronidase, participates in blood fibrinolysis, activates this ability

The benefits of the drug
  • It does not have a systemic effect;
  • not addictive;
  • the risk of side effects is 5%;
  • does not affect the synthesis of cartilage substances – proteoglycans (this applies not only to healthy cartilage, but also to altered osteoarthritic processes)
The drug is not addictive, the risk of side effects is practically eliminated

Anton Epifanov on the use of physiotherapy:

The expediency of using Fastum® gel and Lioton® gel preparations for phonophoresis is dictated by the set of required pharmacodynamic processes. They are provided by the active components of the considered drugs (NSAIDs – ketoprofen and heparin, respectively). And the topical (local) use of drugs, enhanced by phonophoresis, ensures the achievement of the required therapeutic effects without the threat of developing systemic adverse reactions.

Physiotherapeutic methods of treatment are necessary to eliminate inflammation of the ankle joint. The advantages are obvious – a positive effect occurs directly on the affected tissue, the procedures are not addictive, they have a powerful analgesic and decongestant effect.

Folk methods

A patient who feels soreness in the ankle should not rely on dubious methods. Attempts to normalize joint function by warming compresses, applying heated salt are useless.

It is permissible for a patient to use a decoction of chamomile, St. John’s wort, thyme and calendula, but only for the purpose of general health improvement, because to fight the disease you need strong immunity.

With the permission of the doctor, you can wrap the affected area of ​​the limb with a woolen (natural) fabric, since heat provides distracting therapy. But relying on any traditional medicine is reckless: you need to get the help of a doctor.

Surgery

Endoprosthetics of the ankle joint is a promising, but little studied direction. Reconstruction of this part of the musculoskeletal system, no matter how well it was carried out, still potentiates the occurrence of secondary deforming arthrosis. The risk of complications is the result of the following factors:

  • additional damage during surgery;
  • loads on periarticular tissues and their injury;
  • worsening of articular trophism during postoperative recovery.

Even 20 years ago, successful endoprosthetics seemed a pipe dream of orthopedists, traumatologists, and surgeons. Since the risk of complications increased to 60%, and the likelihood that the prosthesis would “take root” was too small. And this despite the ongoing antibiotic therapy, preventing the development of complications, the exact implementation of each action to install prostheses. The problems of the operation of endoprostheses were explained by the imperfection of the design of the device: the plan for the forthcoming intervention was not accurately compiled, poor-quality implantation tools, and technical difficulties in installing the components. After analyzing the early results of surgery and the condition of the ankle, satisfactory results were revealed. But on 3-4 days after the operation, the percentage of normal rates decreased by 3 times.

Clinical observation in European hospitals led to the conclusion that for a long time of use, STAR endoprostheses manufactured by WALDEMAR LINK GmbH & Co. have worked well. KG (Germany), Mobility ™ (DePuy, England), HINTEGRA brands (New Deal SA, France).

In 15 patients with a follow-up period of 6,2 years, it was possible to establish signs of instability and premature wear of the prosthesis components. The performed study showed: the greatest survival of the endoprosthesis is in patients with rheumatoid arthritis and in individuals with reduced motor activity.

Advantages of modern endoprostheses:

  1. The bone cement used in the fixation process is not extruded beyond the endoprosthesis during its installation.
  2. Improved implant models eliminate the need for resection of a significant area of ​​the articular surfaces. Given this factor, the spongy bone is a sufficiently reliable support for fixing bone cement material.
  3. There is no movement of the implants. The prosthesis does not migrate to the distal metaepiphysis of the tibia or the body of the talus.
  4. Surgical trauma does not provoke poor healing of the postoperative wound.
  5. Minimum number of adverse outcomes.

The interest in ankle replacement has returned immediately after the introduction of cementless implants, improving the design (they began to practice implantation of three-component models), and normalizing the quality of surgical instruments.

Complications of arthroplasty

Despite the modernized equipment used to install the prosthesis, according to the experience of doctors, complications develop in 25% of clinical cases after surgery. They arise both in the early and late recovery period. Among the adverse outcomes of EP joints are:

  • infection of the joint that underwent prosthetics (IPA);
  • migration of components of the endoprosthesis, ligamentous apparatus;
  • periosteal and periprosthetic fractures;
  • development of thrombophlebitis, thromboembolism.

IPA – colonization of the bacterial flora that affects one or more structures. These include the site of connection of the bone with the cement material; surface and cavity of the artificial joint; the remainder of the synovial membrane; soft tissues that surround the joint. Infection of the prosthetic joint – an indication for re-hospitalization (if the complication occurred in the late postoperative period) or a reason for extending the length of stay in the department (with the early appearance of an aggravating phenomenon). The doctor’s tactics are complicated by the need for volumetric revision operations. This action not only worsens the well-being of the patient – it increases the risk of death.

Conclusion

Inflammation of the ankle joint, the development of which could not be prevented, can be cured. To do this, consult a doctor at the first sign of a worsening limb condition. Conservative therapy and surgical techniques can restore leg function. Modern possibilities of ankle joint replacement allow the full operation of the implant for 6 years. After this time, a visit to the doctor and a follow-up examination will be required to make sure that there are no hidden complications. In general, the prognosis for recovery is favorable, but subject to early seeking medical help.

Shishkevich Vladimir

Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews. It specializes in the treatment of diseases in orthopedic, traumatological, vertebrological profiles

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