Arthritis of an ankle joint
Arthritis of an ankle joint - the sharp or chronic inflammatory process affecting the anatomical structures forming a joint of bones of a shin with foot. At arthritis of an ankle joint pain, hyperaemia, a hyperthermia and hypostasis in a joint, restriction of mobility of foot develops. The diagnosis of arthritis of an ankle joint is based on data of a clinical picture, X-ray analysis, ultrasonography, MRT of a joint, laboratory researches, a diagnostic puncture and an arthroscopy. At arthritis of an ankle joint rest, anti-inflammatory, soothing, antibacterial medicines, physiotreatment are shown; according to indications the arthroscopic sinovektomiya, prosthetics of a joint is carried out.
Arthritis of an ankle joint
Arthritis of an ankle joint – inflammatory and destructive defeat of elements of an ankle joint of various genesis. Arthritis of an ankle joint can develop at any age; more males are subject to a disease. This articulate pathology is widespread around the world, in many respects defines quality of life of patients and causes serious concern of experts in the field of rheumatology and traumatology. The ankle joint is created by tibial, low-tibial, calcaneal and collision bones; thanks to the complex structure it has very big mobility. Blokovidny in a form, provides an ankle joint to foot of function of rotation, bending (the movement towards its plantar surface), extensions (the movement towards its back surface) with the size of mobility 90 °. When bending foot its some reduction and assignment is possible. The ankle joint is exposed to enormous loadings, maintaining the weight of own body.
Reasons of arthritis of an ankle joint
Arthritis of an ankle joint can arise against the background of degenerate and dystrophic diseases of joints (osteoarthrosis), exchange violations (gout), system pathology (a peripheral form of a disease of Bekhterev, a system red volchanka, psoriasis), after the postponed infection. Violation of immune responsiveness at system diseases leads to the fact that own articulate fabrics are perceived by immune system as alien and are exposed to aggressive influence of antibodies. At rheumatoid arthritis first of all the inflammation of a sinovialny cover of an ankle joint which is followed by its growth, damage of a cartilage and bone tissue, accretion of articulate surfaces develops. The jet arthritis of an ankle joint arising after bacterial and viral infections is connected with the increased immune reaction to activator anti-genes. At their proximity with fabric anti-genes of joints the jet aseptic inflammation develops.
At children arthritis of an ankle joint is often provoked by intestinal and respiratory infections (dysentery, salmonellosis, , flu, mikoplazmenny and chlamydial infections), and also allergic reactions to certain irritants (foodstuff, pollen of plants, hair of animals). Improper feeding, addictions, excess weight, stressful situations, adverse conditions of the environment (the increased humidity, overcooling, insanitary conditions) contribute to development of arthritis.
Psoriatichesky arthritis is associated with defeat of an integument and develops at persons with hereditary predisposition. Permanent violation of the general metabolism at gout leads to a surplus and adjournment of crystals of uric acid in a cavity of an ankle joint with development in it reciprocal inflammatory reaction.
Post-traumatic arthritis of an ankle joint is caused by a sharp trauma of articulate fabrics (the articulate capsule, cartilages, the copular device or muscles and sinews) owing to bruises, dislocations, fractures, stretching and a rupture of sheaves. Long physical activity on an ankle joint and flat-footedness cause a chronic mikrotravmatization of a joint and the copular device of foot, also promoting emergence of arthritis. Purulent arthritis meets seldom, at the getting wound of an ankle joint hit in his cavity of a gnoyerodny infection or at its distribution from the inflammatory center in the limfogenny and hematogenic way.
Classification of arthritis of an ankle joint
Arthritis of an ankle joint can proceed in a sharp and chronic form. Depending on the reason, distinguish primary (at direct damage of a joint) and the secondary arthritis (which developed against the background of extra articulate pathology).
On the nature of inflammatory process arthritis of an ankle joint can be nonspecific (purulent), specific (tubercular, gonorrheal, etc.) and aseptic (jet, rheumatoid and so forth). Serve as the most typical forms of damage of an ankle joint gouty, jet, post-traumatic, psoriatichesky and rheumatoid arthritis.
Arthritis of an ankle joint can develop separately (monoarthritis), but arises along with an inflammation in other joints more often (oligoartrit, polyarthritis). Damage of an ankle joint at arthritis can be unilateral (a trauma, an infection), bilateral (system pathology) and migrating (gout).
Symptoms of arthritis talocrural joint
Sharp arthritis of an ankle joint develops suddenly, more often at night. Sharply arisen morbidity is followed by bystry emergence of hyperaemia and puffiness, local temperature increase in the field of soft tissues of a joint, considerable restriction of mobility of foot, difficulty of movement. The general intoxication is characteristic of purulent arthritis of an ankle joint; fever, fever, weakness, headache.
The chronic form of a disease develops gradually. Hyperaemia and puffiness of an ankle joint are expressed poorly; morning constraint and painful feelings at the movement, the maximum bending and extension of a joint are noted, during the clothing and removal of footwear.
Allocate several stages of development of arthritis of an ankle joint. At the I stage of pain appear only at the movement and stop at rest; constraint and reduction of mobility of foot – are insignificant. The II stage of arthritis of an ankle joint is shown by the constant expressed pain which is not passing in rest, strengthening of painful reaction "on weather", noticeable decrease in mobility of foot. At the III stage of arthritis because of sharp loss of mobility of an ankle joint of the patient can move only by means of a stick or crutches. Foot is strongly deformed, adopts the unnatural provision, the anchylosis leading to the patient's invalidization develops.
The clinical picture of arthritis of an ankle joint can vary depending on the inflammation reason. Rheumatoid arthritis of an ankle joint is characterized by symmetric defeat with a constant pain syndrome, and when involving in inflammatory process of the copular device is followed by instability of an ankle with frequent incomplete dislocations and dislocations. Development of jet arthritis of an ankle joint is always preceded by the postponed urinogenital, intestinal or respiratory and viral infection. At a syndrome of Reuters arthritis of an ankle joint is followed by damage of eyes (conjunctivitis), an infection of urinary tract (uretrity, prostatitis).
Diagnosis of arthritis of an ankle joint
The diagnosis of arthritis of an ankle joint is based on data of poll of the patient; clinical picture, results of a X-ray analysis, ultrasonography, KT and MPT of ankle joints, laboratory researches. The X-ray analysis at arthritis of an ankle joint allows to find symptoms of osteoporosis, availability of liquid or pus in a joint cavity; erosion, cysts, destructive changes of bone substance, flattening of articulate surfaces, reduction of an articulate crack, anchylosis. MRT of an ankle joint is more informative since it reveals even insignificant aberrations not only a bone tissue, but also an articulate cartilage, sheaves and soft fabrics.
From laboratory methods of inspection the general and biochemical blood test and urine, IFA, RNGA, a research of a rheumatoid factor, crops of blood on sterility is made. If necessary the diagnostic puncture with a research of sinovialny liquid or an arthroscopy with a biopsy of tissues of joint is carried out.
Treatment of arthritis of an ankle joint
Treatment of arthritis of an ankle joint is performed by the rheumatologist or the traumatologist-orthopedist and includes complex medicamentous and non-drug therapy. At arthritis of an ankle joint the mode with the minimum load of foot is shown: absolute rest or an immobilization by means of an elastic bandage, when walking – use of a cane; observance of a diet with an exception of greasy, salty, spicy, smoked, tinned food.
Within pharmacotherapy NPVS, analgetics, glucocorticosteroids (in the form of intra articulate injections, periartikulyarny blockade, system therapy), antibacterial medicines of a broad spectrum of activity (are applied at infectious genesis), vitamins. Carrying orthopedic inserts in footwear ("bioprosthetics") or specially made footwear is recommended. At arthritis of an ankle joint out of an aggravation physiotherapy (Ural federal district, a medicinal electrophoresis, a parafinolecheniye, mud cure), massage, remedial gymnastics and sanatorium treatment is appointed.
At purulent arthritis the arthroscopy with drainage of a cavity of an ankle joint is carried out. At the resistant recidivous course of rheumatoid arthritis the arthroscopic sinovektomiya is shown. At the severe deforming forms of a disease carrying out an arthroscopic artrodez of an ankle joint or endoprosthesis replacement is required.
Forecast and prevention of arthritis of an ankle joint
Arthritis of an ankle joint is inclined to a long recidivous current. The forecast is defined by the reason of development of arthritis: at a jet form it is more favorable; at the rheumatoid and psoriatichesky defeat leading to heavy deformation and loss of physical activity of an ankle joint - more serious. Prevention of inflammatory and destructive damage of a joint includes correction of a way of life, food allowance, body weight; refusal of addictions, feasible physical activity, timely treatment of infectious diseases and injuries.