Arthrosis of an ankle joint is the chronic disease affecting articulate cartilages, and in the subsequent and other structures of a joint (the capsule, a sinovialny cover, bones, sheaves). Has degenerate and dystrophic character. It is shown by pains and restriction of movements, in the subsequent the progressing violations of functions of a support and walking are noted. The diagnosis is exposed on the basis of symptoms, these survey and a X-ray analysis. Treatment is usually conservative, anti-inflammatory medicines, hondroprotektor and glucocorticoids are used, LFK and physiotreatment is appointed. In hard cases it is carried out sanatsionny art rock opium, or endoprosthesis replacement.
Arthrosis of an ankle joint
Arthrosis of an ankle joint – a disease at which articulate the cartilage and surrounding fabrics gradually collapses. Diseases are the cornerstone degenerate and dystrophic processes, the inflammation in a joint has secondary character. Arthrosis has a chronic wavy current with alternation of remissions and aggravations, and gradually progresses. Women and men suffer equally often. The probability of development sharply increases with age. At the same time, experts note that the disease "looks younger" - every third case of arthrosis of an ankle joint comes to light at persons more young than 45 years now.
Primary arthrosis arises without any visible reasons. Secondary develops under the influence of some adverse factors. In either case violation of exchange processes in cartilaginous tissue is the cornerstone. The main reasons and the contributing factors of development of secondary arthrosis of an ankle joint are:
- Large injuries of a joint (fractures of a collision bone, fractures of anklebones, anguishes and ruptures of sheaves). Ankle
- joint operations.
- Excessive loading: too intensive sports activities, long walking or constant stay in a standing position caused by working conditions.
- Wearing footwear on heels.
- Excessive weight.
- Constant microinjuries.
- The diseases and states connected with a metabolic disorder (diabetes, gout, pseudo-gout, a lack of estrogen of a postmenopause).
- Rheumatic diseases (hard currency, rheumatoid arthritis).
- Osteochondrosis of lumbar department of a backbone, intervertebral hernias and other states which are followed by infringement of nerves and violation of operation of the muscular device of foot and a shin.
Nonspecific purulent arthritis, arthritis at specific infections (tuberculosis, syphilis) become more rare the cause of arthrosis and congenital anomalies of development. A part in development of arthrosis is played by an adverse ecological situation and hereditary predisposition.
Articulate surfaces smooth, elastic are normal. They freely slide from each other during movements and provide effective depreciation at loading. As a result of mechanical damage (trauma) or violation of exchange processes the cartilage loses smoothness, becomes rough and inelastic. Cartilages "rub" at the movements and injure each other more and more that leads to aggravation of pathological changes. Because of insufficient depreciation excess loading is transferred to the subject bone, and in it degenerate and dystrophic violations develop too: the bone is deformed and expands at the edges of the articulate platform.
Not only the cartilage and bone, but also surrounding fabrics suffers because of a secondary travmatization and violation of normal biomechanics of a joint. The capsule of a joint and a sinovialny cover are thickened, in ligaments and circumarticular muscles the centers of fibrous regeneration are formed. Ability of a joint to participate in the movements and to maintain loadings decreases. The joint becomes unstable, the pain syndrome progresses. In hard cases articulate surfaces collapse, basic function of an extremity is broken, the movements become impossible.
In the beginning there is a bystry fatigue and unsharp pains after considerable loading. In the subsequent the pain syndrome becomes more intensive. Pains develop not only after loading, but also at night. Visible deformation is gradually formed, the volume of movements in a joint decreases, at the movements the crunch is heard. At late stages of the movement contractures sharply are limited, develop. The support is at a loss, at movement patients are forced to use crutches or a cane. Distinctive features of a pain syndrome and other symptoms at arthrosis:
- Starting pains which arise after a condition of rest are characteristic, and then gradually disappear at the movements.
- Strengthening of pains at loading is noted and bystry fatigue of a joint.
- At the movements there can be a crunch, a scratch or clicks.
- Night pains usually develop at daybreak.
- In the period of an aggravation the area of a joint can be swelled up a little and reddened.
- Because of instability of a joint the patient often sprains a leg, there are stretchings and anguishes of sheaves.
- Constraint and restriction of movements is noted.
- At late stages the expressed deformation of a joint comes to light.
The diagnosis is exposed on the basis of poll, yielded survey and results of additional researches. The crucial role in diagnosis and definition of degree of arthrosis is played by a joint X-ray analysis. Narrowing of an articulate crack, growth of edges of articulate surfaces (osteofita) testifies to arthrosis. At late stages kistovidny educations and an osteosclerosis subkhondralny (located under a cartilage) bone zones come to light. In difficult cases for more exact assessment of a condition of bone structures of the patient in addition direct to a computer tomography, for a research of soft fabrics – to a magnetic and resonant tomography. If necessary for identification of the reason of arthrosis and differential diagnostics with other diseases appoint consultations of adjacent experts: neurologist, rheumatologist, endocrinologist.
Treatment of arthrosis of an ankle joint
Treatment of pathology long, complex. Usually patients are observed by the orthopedic surgeon on an outpatient basis. In the period of an aggravation hospitalization in office of orthopedics is possible. An important role in delay of progressing of arthrosis is played by a way of life and the correct mode of physical activity therefore to the patient make recommendations about weight reduction and optimization of load of a leg. The complex of physiotherapy exercises developed taking into account manifestations and a stage of a disease is appointed. The patient is directed to physiotherapy. At treatment of arthrosis apply massage, UVCh, laser therapy, thermal procedures (ozokerite, paraffin), a medicinal electrophoresis and .
Medicamentous therapy is also selected taking into account symptoms and a stage of a disease. In the period of an aggravation appoint nonsteroid anti-inflammatory medicines of the general action: indometacin, to meloksika, diclofenac. Means of this group exert negative impact on a mucous membrane of a stomach therefore at diseases of a gastrointestinal tract or apply the "sparing" medicines (, ), or use NPVP of external application, in the form of ointments. Along with anti-inflammatory therapy recommend the anesthetizing local means in the form of ointments and gels. At the expressed pain syndrome which does not manage to be stopped by means of medicines carry out intra articulate introduction of corticosteroids with frequency not more often than 4 times a year.
All these means only eliminate pain and an inflammation, but do not influence the arthrosis reason therefore along with the listed medicines to the patient appoint hondroprotektor – the substances contributing to normalization of exchange processes in cartilaginous tissue. Means of hondroprotektorny group apply in the form of creams, gels and medicines for intra articulate introduction. Use the medicines containing a glycosamine and a hydrolyzate of collagen. For improvement of local blood circulation and activization of fabric exchange appoint and nicotinic acid.
At inefficiency of conservative therapy carry out surgical interventions on joints, perform endoprosthesis replacement. At considerable destruction of a cartilage carry out an arthroscopic hondroplastika. The Sanatsionny arthroscopy is usually made at the expressed pains on 2 stages of arthrosis. During operation the orthopedist by means of an artroskop deletes from an articulate cavity freely lying splinters of a cartilage, an osteofita and other educations causing pains and obstructing the traffic in a joint. The effect of surgical intervention remains within several years.
At considerable destruction of articulate surfaces it can be executed an ankle joint – removal of a joint and "merging" of bones of foot and a shin. As a result pains disappear, basic function of an extremity is restored. At the same time, it is impossible to call this method physiologic – the patient can use an extremity due to preservation of mobility of other joints, however it creates difficulties at movement and significantly limits working capacity. The most effective and physiologic operation at late stages of arthrosis is endoprosthesis replacement – removal of the destroyed articulate surfaces of bones and their replacement with plastic, ceramic or metal artificial limbs. The movements after such interventions are restored in full, service life of an artificial limb makes 20-25 years.