Contracture of the ankle joint is a typical complication of long-term musculoskeletal diseases without appropriate treatment. This could be arthritis, arthrosis, ligament rupture, diastasis of the tibia and fibula, etc. This pathology provokes joint stiffness, which invariably affects gait and the ability to move independently for a long time. With a pronounced degree of stiffness, the foot is fixed in one position and the patient experiences difficulty walking, and even more so running.
In this material we will analyze the main reasons for the development of contracture of the ankle joint, the clinical symptoms of this pathology and methods of treating it without the use of surgery. The main methods of rehabilitation are considered, which allow you to restore the mobility of the foot and return freedom of movement to the patient.
Ankle contracture often develops after repeated soft tissue trauma. This may be a sprain or rupture of ligaments, muscle damage, divergence of the heads of the tibia and fibula when the integrity of the cartilage that connects them is violated. Stiffness develops gradually. There is a reduction in the length of ligaments, tendons and muscles. Therefore, it is very difficult to notice pathological changes at the initial stage. But if they appear, you should immediately seek medical help. Only an experienced doctor can correctly understand the potential causes of the disease. He will eliminate the possibility of one reason or another, give individual recommendations on choosing suitable shoes, organizing your work process, etc. Then an individual rehabilitation course will be developed. It will restore mobility in the ankle and eliminate the risk of progression of this disease in the future.
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Reasons for the development of ankle contracture
There are various reasons for the development of ankle contracture. The most common at a young age is the traumatic nature of the disease. In this case, the person leads an active, mobile lifestyle and plays sports. A traumatic effect on the ligamentous and tendon apparatus is invariably provoked. It undergoes regular stretching. Then, scar deformities form in places of microscopic ruptures. They reduce joint mobility and promote stiffness.
In old age, ankle contracture most often occurs against the background of osteoporosis, which provokes the destruction of bone tissue. After an ankle fracture or tibial fracture, it becomes necessary to immobilize the foot for a long period of time. The joint capsule contracts, the amount of synovial fluid in it decreases. Against the background of senile degenerative changes in the body, ankylosis of the joint may begin to form. This will lead to a decrease in the amplitude of his mobility in the future.
Other potential causes of ankle contracture include:
- desmogenic changes of an inflammatory and degenerative nature in the ankle area (ligaments, tendons, subcutaneous fatty tissue, etc. are damaged);
- infectious damage to the subcutaneous tissue, for example, erysipelas;
- deep burns and other sclerotic and cicatricial deformations of the skin, which significantly reduce the range of mobility of the foot;
- muscle atrophy and dystrophy, including those arising due to prolonged immobilization of the lower limb;
- disruption of the process of tissue innervation (may be a consequence of lumbosacral osteochondrosis with radicular syndrome, intervertebral disc herniation, plexitis, cauda equina syndrome, pinched nerve at the bifurcation point in the popliteal fossa, etc.);
- insufficiency of blood supply with the development of varicose veins of the lower extremities, atherosclerosis, diabetic angiopathy, etc.
If there are potential causes, there is a high probability of developing pathological changes in the tissues, against the background of which a violation of the mobility of the ankle joint occurs. Risk factors are also important:
- excess body weight, which creates an increased risk of injury at home and at work;
- maintaining a sedentary lifestyle, in which the muscles of the lower extremities lose their efficiency and tone, necessary to support all joints during movements;
- incorrect choice of shoes for sports and everyday wear;
- incorrect placement of the foot (flat feet or club feet), due to which there is an uneven distribution of shock-absorbing load on the tissues of the foot;
- degenerative diseases of large joints of the lower extremities;
- heavy physical labor associated with prolonged standing.
All these risk factors should be gradually eliminated from your daily life. In this way, it is possible to effectively prevent injuries and the development of contracture of the ankle joint.
Massage of the periosteum of the leg
Massage is used as one of the methods of treating periostitis - inflammation of the periosteum. Most often it has a traumatic origin. Severe immediate trauma or constant microtraumatization provokes an aseptic inflammatory reaction. Tension periostitis or periostopathy are more common. One is subacute or chronic. Initially, only the periosteum becomes inflamed. Then muscles, bones, ligaments, and tendons can be involved in the process.
The patient is positioned on his back. A bolster is placed under the knee. The leg bends at the knee. The doctor massages the calf muscle. He uses the following moves:
Types of Ankle Contracture
Ankle contracture is divided into different types. First of all, classification is carried out due to the development of pathology:
- post-traumatic occurs after a bruise, crack, fracture, dislocation, rupture of ligaments;
- postoperative can develop as a complication after restoration of the integrity of the ankle ligaments;
- necrotic – occurs after tissue damage by aseptic or infectious necrosis;
- osteoporotic – is a consequence of the destruction of bone tissue;
- degenerative dystrophic - a companion to osteoarthritis or heel spurs.
Also in the classification of backlight, it matters in what plane the limitation of mobility is observed. Equinus contracture of the ankle joints most often occurs in early childhood. It is formed in babies at a time when they are just getting on their feet and starting to take their first steps. At the same time, they try to walk on their toes. For this reason, this type of contracture is called ballerina syndrome.
Flexion contracture of the ankle joint often develops due to degenerative dystrophic damage to the cartilage tissue of the ankle joint. When the cartilaginous shells are destroyed, bone tissue begins to deteriorate, and rough osteophytes - bone spines - form on the articular surfaces, which injure the surrounding tissues. As a result, a gradual decrease in the amplitude of joint mobility is observed.
Mixed contracture of the ankle joint is characterized by the fact that mobility is limited simultaneously in several planes. The patient cannot independently bend and straighten the foot, or make lateral and circular movements. This type of lesion is considered the most difficult and requires a long period of full rehabilitation.
Massage of the periosteum of the leg
Massage of the periosteum of the leg
- continuous stroking with grasping;
- kneading;
- shaking.
After this, they move on to the anterior muscle group. Direct and spiral stroking are used. Next, knead with the thumb and the base of the palmar surface of the hand.
At the final stage, they move to the back of the foot. Do rubbing with fingertips. At the end, stroking is performed with the fingertips from the knee to the ankle. The total duration of the procedure is 10 minutes.
Based on the characteristics of the clinical situation, you can massage the thigh and lower leg, as well as the knee. In this case, they start from the overlying sections of the leg, gradually moving down. The thigh is massaged, then the knee, and only after that the ankle and foot are massaged.
Post-traumatic contracture of the ankle joint
Contracture of the ankle joint after a fracture of the ankle, tibia or fibula can form as a result of prolonged immobilization of the limb. Incorrectly applied plaster cast, lack of basic therapeutic exercises, complications - this is not a complete list of reasons why post-traumatic contracture of the ankle joint is formed.
The first step towards restoring joint mobility is to see an orthopedist. This specialist must conduct a full diagnosis, during which the potential cause of stiffness is determined.
If this is ankylosis of the joint due to effusion of fibrin into the joint capsule or penetration of blood, then before starting rehabilitation it is necessary to conduct a course of resorption therapy. This is best done through massage, reflexology and physiotherapy.
If the contracture has formed against the background of muscle fiber dystrophy or a reduction in the length of the ligamentous and tendon apparatus, then treatment can begin with therapeutic exercises and kinesiotherapy in combination with osteopathy.
Post-traumatic contracture of the ankle joint has a number of features:
- formed during the period of immobilization of the lower limb;
- differs in that the amplitude of mobility decreases in all projections and planes simultaneously;
- without modern treatment, it gradually progresses, leading to complete immobility of the joint;
- may cause a sudden change in gait;
- in advanced cases, it causes flat feet or club feet.
An orthopedist treats post-traumatic contracture of the ankle joint. During rehabilitation measures, it is recommended to exclude heavy physical activity on the lower extremities. Some experts recommend wearing special orthopedic shoes. But you should not give in to such recommendations. This can only make the existing problem worse.
A competent doctor will conduct a rehabilitation course without orthopedic shoes and completely restore the mobility of the ankle joint.
Which is better: arthrodesis or endoprosthetics?
It is not possible to answer this question unambiguously. Until now, arthrodesis is considered the “gold standard” of operations for arthrosis of the ankle joint, but world statistics indicate a steady increase in the number of endoprosthetics operations. Very important factors influencing the efficiency of operations and patient satisfaction with the results are:
- patient's age at the time of surgery;
- the patient's level of physical activity;
- a history of injuries to the bones of the leg and foot.
The younger the patient, the higher his physical activity, the higher the risk of aseptic instability of the endoprosthesis components. Fractures of the ankles, talus and calcaneus in the ankles contribute to the same phenomenon. Therefore, arthrodesis surgery is more suitable for this category of patients, since endoprosthetics is highly likely to be unsuccessful and, after several months or years, arthrodesis will have to be performed.
Arthrodesis option.
Older patients with low motor activity are more suitable for endoprosthetics - they have a slightly lower likelihood of instability.
Employees of the Federal State Budgetary Institution “Russian Research Institute of Traumatology and Orthopedics named after. R.R. Harmful" - K.S. Mikhailov, V.G. Emelyanov et al. - an algorithm for choosing an operation for patients with defarthrosis of the ankle joint was proposed and introduced into clinical practice (https://cyberleninka.ru/article/n/obosnovanie-vybora-operatsiy-artrodezirovaniya-ili-endoprotezirovaniya-u-patsientov- s-artrozom-golenostopnogo-sustava - source).
Advantages of ankle arthrodesis:
- fewer complications;
- the joint is fixed immediately and forever;
- less effort on rehabilitation;
- fairly low price of consumables (intramedullary nails) and surgery.
But we should not forget about the disadvantages of arthrodesis:
- due to disturbances in the biomechanics of movements, arthrosis of other joints (hip, knee) develops
- higher likelihood of pain persisting in the postoperative period;
- the need for long-term fixation of the leg after surgery.
Advantages of endoprosthetics:
- the biomechanics of movements is restored, which has a positive effect on the condition of other joints;
- the joint fixation time is significantly lower - functional rehabilitation without load begins within a couple of weeks;
- after endoprosthetics, more than 75% of patients report complete disappearance of pain.
Disadvantages of ankle replacement:
- the operation is technically more complex;
- greater likelihood of postoperative complications;
- longer rehabilitation;
- high cost of surgery and endoprosthesis.
In any case, the final choice of surgery remains with the patient, but when choosing, the specified factors and the opinion of orthopedic doctors should be taken into account.
Treatment of ankle contracture
To treat ankle contracture, you need to go to specialized clinics. The rehabilitation is carried out by an orthopedist. This doctor diagnoses the patient’s condition and develops an individual recovery course depending on which muscles, ligaments and tendons have suffered the most.
Self-treatment is not recommended. There is a high probability of injury to tissues that have undergone degeneration and dystrophy. Treatment of ankle contracture will be successful if you first ensure that full blood supply to all tissues around the joint is restored. Osteopathy can be used for this - it allows you to improve the process of microcirculation of blood and lymphatic fluid in the lesion. Physiotherapy methods can also speed up the metabolic process in places where the integrity of soft and bone tissues is damaged.
Physical therapy plays a special role in the treatment of ankle contracture, since it helps restore the elasticity of all tissues: ligaments, tendons, muscles. It tones blood vessels and accelerates blood flow, improves the condition of muscle fiber, etc. It is best to combine sessions of therapeutic exercises or kinesiotherapy with massage or osteopathy. It is also recommended to use reflexology methods. Due to acupuncture, it has a beneficial effect on biologically active points on the human body. This starts the process of regeneration of damaged tissues and improves the general condition of the patient.
Laser treatment of joints in the formation of contracture is practiced. This effect ensures restoration of mobility. It launches natural tissue regeneration processes.
If you are developing ankle contracture and need quick and safe treatment, you can book a free appointment with our manual therapy clinic right now. Experienced doctors work here. They will conduct a full examination, make an accurate diagnosis and talk about the prospects and possibilities for rehabilitation in your individual case.
Varus deformity of the leg
In childhood, varus curvature of the legs is amenable to conservative therapy. To normalize the position of the legs, orthopedic shoes and special exercises are used. Massage is used as an additional therapeutic method.
For varus deformity of the leg, massage is done as follows:
1. The child lies on his stomach.
2. Place a cushion under the ankle.
3. Massage the buttocks: circular or cross-shaped stroking, rubbing, kneading, percussion techniques.
4. Massage the thigh. They stroke it, rub it, knead it, stroke it again.
5. Move to the knee. Make a large number of stroking movements. Then – rubbing, pressing on the area of the lateral condyle.
6. Carry out a gentle massage of the lower leg. They stroke it, rub it, knead it, shake it. Then massage is performed in the calf muscle area. Its lateral part is massaged more intensively. The Achilles tendon is bypassed.
6.4. Pneumoorthoses for the prevention and treatment of contractures
Recently, in our practice, we have successfully used pneumoorthoses for the prevention and treatment of contractures. These devices can significantly facilitate the work of exercise therapy methodologists. Pneumoorthoses provide a given rhythm and strength of flexion and extension of the limbs, which allows not only to prevent the development of contractures, but also to quickly develop already formed contractures.
Pneumoorthoses are also effective for paralysis of the muscles of the limbs.
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