Ankle arthritis is an acute or chronic inflammatory process affecting the anatomical structures that form the articulation of the bones of the lower leg with the foot. With disease joint, there is pain, hyperemia, hyperthermia and swelling in the joint area, limited mobility of the foot. The diagnosis is based on the data of the clinical picture, radiography, ultrasound, MRI of the joint, laboratory tests, diagnostic puncture and arthroscopy. With ankle arthritis , rest, anti-inflammatory, painkillers, antibacterial drugs, physiotherapy are indicated; according to the indications, arthroscopic synovectomy, joint prosthetics are performed.
M13.8 Other refined arthritis
Ankle arthritis is an inflammatory and destructive lesion of the elements of the ankle joint of various genesis. Ankle arthritis can develop at any age; men are more susceptible to the disease. This joint pathology is widespread all over the world, largely determines the quality of life of patients and causes serious concern to specialists in the field of rheumoortopedia.
Causes of ankle arthritis
Ankle arthritis can occur against the background of degenerative-dystrophic joint diseases (osteoarthritis), metabolic disorders, systemic pathology (peripheral form of Bekhterev’s disease, systemic lupus erythematosus), after infection. The direct etiofactors are:
- Systemic inflammation. Violation of immune reactivity in systemic diseases leads to the fact that their own joint tissues are perceived by the immune system as foreign and are aggressively exposed to antibodies. In rheumatoid arthritis, first of all, inflammation of the synovial membrane of the ankle joint develops, accompanied by its proliferation, damage to cartilage and bone tissue, fusion of articular surfaces.
- Infectious antigens and allergens. Reactive ankle arthritis, which occurs after bacterial and viral infections, is associated with an increased immune response to pathogen antigens. When they are close to the tissue antigens of the joints, reactive aseptic inflammation develops. In children, ankle arthritis is often provoked by intestinal and respiratory infections (dysentery, salmonellosis, yersiniosis, influenza, mycoplasma and chlamydia infections), as well as allergic reactions to certain irritants (food, plant pollen, animal hair).
- Psoriasis. Psoriatic arthritis is associated with skin lesions and develops in individuals with a hereditary predisposition.
- Gout. Persistent violation of the general metabolism in gout leads to an overabundance and deposition of uric acid crystals in the cavity of the ankle joint with the development of an inflammatory response and gouty arthritis in it.
- Trams. Post-traumatic arthritis is caused by acute injury of articular tissues (articular capsule, cartilage, ligamentous apparatus or muscles and tendons) due to bruises, dislocations, fractures, sprains and ruptures of ligaments. Prolonged physical exertion on the ankle joint and flat feet cause chronic microtraumatization of the joint and ligamentous apparatus of the foot, also contributing to the appearance of arthritis. Purulent arthritis is rare, with a penetrating wound of the ankle joint with a purulent infection entering its cavity or with its spread from the inflammatory focus by lymphogenic and hematogenic pathways.
Improper nutrition, bad habits, excess weight, stressful situations, unfavorable environmental conditions (high humidity, hypothermia, unsanitary conditions) predispose to the development of arthritis.
The ankle joint is formed by the tibial, fibular, calcaneal and talus bones; due to its complex structure, it has very great mobility. Block-shaped in shape, the ankle joint provides the foot with the functions of rotation, flexion (movement towards its plantar surface), extension (movement towards its back surface) with a mobility value of 90 °. When bending the foot, it is possible to bring it and lead it away. The ankle joint is subjected to enormous loads, withstanding the weight of its own body.
Ankle arthritis can occur in an acute and chronic form. Depending on the cause, there are primary (with direct damage to the joint) and secondary arthritis (developed against the background of extra-articular pathology). By the nature of the inflammatory process , this diseaase can be:
- nonspecific (purulent);
- specific (tuberculosis, gonorrhea, etc.);
- aseptic (reactive, rheumatoid, etc.).
The most typical forms of ankle joint damage are gouty, reactive, post-traumatic, psoriatic and rheumatoid arthritis.
Disease can develop in isolation (monoarthritis), but more often occurs simultaneously with inflammation in other joints (oligoarthritis, polyarthritis). The defeat of the ankle joint in arthritis can be unilateral (injury, infection), bilateral (systemic pathology) and migratory (gout).
Symptoms of ankle arthritis
Acute ankle arthritis develops suddenly, more often at night. The sudden soreness is accompanied by the rapid appearance of hyperemia and swelling, a local increase in temperature in the soft tissues of the joint, a significant restriction of the mobility of the foot, difficulty of movement. Purulent arthritis of the ankle joint is characterized by general intoxication; chills, fever, weakness, headache.
The chronic form of the disease develops gradually. Hyperemia and swelling of the ankle joint are poorly expressed; morning stiffness and painful sensations are noted when moving, maximum flexion and extension of the joint, when dressing and taking off shoes.
There are several stages of the development of arthritis.
At stage I, pain in the ankle appears only when moving and stops at rest; stiffness and decreased mobility of the foot are insignificant.
Stage II arthritis of the ankle joint is manifested by constant pronounced pain that does not pass at rest, increased pain response “to the weather”, a noticeable decrease in mobility of the foot.
At the third stage of arthritis, due to a sharp loss of mobility of the ankle joint, the patient can move only with the help of a stick or crutches. The foot is severely deformed, takes an unnatural position, ankylosis develops, leading to disability of the patient.
The clinical picture may vary depending on the cause of inflammation. Rheumatoid arthritis of the ankle is characterized by a symmetrical lesion with a constant pain syndrome, and when the ligamentous apparatus is involved in the inflammatory process, it is accompanied by instability of the ankle with frequent subluxations and dislocations. The development of reactive arthritis of the ankle joint is always preceded by a transferred genitourinary, intestinal or respiratory viral infection. In Reiter’s syndrome, ankle arthritis is accompanied by eye damage (conjunctivitis), urinary tract infection (urethritis, prostatitis).
The diagnosis is based on the patient’s survey data; clinical picture, results of radiography, ultrasound, CT and MRI of the ankle joints, laboratory studies:
- X-ray. Radiography for arthritis of the ankle joint allows you to detect signs of osteoporosis, the presence of fluid or pus in the joint cavity; erosion, cysts, destructive changes in bone matter, flattening of articular surfaces, reduction of the articular gap, ankylosis.
- MRI. MRI of the ankle joint is more informative, because it reveals even minor deviations from the norm not only of bone tissue, but also of articular cartilage, ligaments and soft tissues.
- Analyzes. From laboratory methods of examination, a general and biochemical analysis of blood and urine, ELISA, IHA, rheumatoid factor examination, blood culture for sterility is performed.
- Additional diagnostics. If necessary, a diagnostic puncture with a study of synovial fluid or arthroscopy with a biopsy of joint tissues is performed.
Treatment of ankle arthritis
Treatment of arthritis of the ankle joint is carried out by a rheumatologist-arthrologist or traumatologist-orthopedist and includes complex drug and non-drug therapy. With arthritis of the ankle joint, a regime with minimal load on the foot is shown: complete rest or immobilization with an elastic bandage, when walking – the use of a cane; adherence to a diet with the exception of fatty, salty, spicy, smoked, canned food.
- Drug therapy. As part of pharmacotherapy, NSAIDs, analgesics, glucocorticosteroids (in the form of intra-articular injections, periarticular blockades, systemic therapy), broad-spectrum antibacterial drugs (with infectious genesis), vitamins are used.
- Orthopedic correction. It is recommended to wear orthopedic inserts in shoes (“bioprosthetics”) or specially made shoes.
- Physical therapy. With arthritis of the ankle joint, physiotherapy (UIB, medicinal electrophoresis, paraffin treatment, mud treatment), massage, therapeutic gymnastics and spa treatment are prescribed outside of exacerbation.
- Orthopedic operations. With purulent arthritis, arthroscopy is performed with drainage of the ankle joint cavity. With a persistent recurrent course of rheumatoid arthritis, arthroscopic synovectomy is indicated. In severe deforming forms of the disease, arthroscopic arthrodesis of the ankle joint or endoprosthetics is required.
Prognosis and prevention
Arthritis of the ankle is prone to a long-term recurrent course. The prognosis is determined by the cause of the development of arthritis: with a reactive form, it is more favorable; with rheumatoid and psoriatic lesions, leading to severe deformation and loss of motor activity of the ankle joint, it is more serious. Prevention of inflammatory and destructive joint damage includes correction of lifestyle, diet, body weight; rejection of bad habits, feasible motor activity, timely treatment of infectious diseases and injuries.