Post-traumatic arthrosis of the ankle joint is a degenerative disease caused by various injuries. The development of pathology is provoked by intra-articular fractures and damage to the connective tissue elements of the ligamentous-tendon apparatus. Characteristic symptoms of post-traumatic ankle arthrosis are pain, limitation of movements, and deformation of the joint.
Old injuries.
When diagnosing pathology, anamnesis and clinical data are taken into account. Instrumental studies are required - radiography, CT, ultrasound, MRI, arthroscopy. Conservative methods are used in therapy, but sometimes there is a need for endoprosthetics.
Causes
Post-traumatic arthrosis occurs due to a violation of the integrity of the joint surface, prolonged immobilization of the limb, and insufficient supply of the ankle with oxygen, nutrients and biologically active substances. The most common causes of pathology:
- intra-articular fractures, in which bone fragments are displaced, damaging soft tissue structures;
- rupture of the ligamentous-capsular apparatus (interfibular syndesmosis);
- combination of a comminuted fracture with damage to ligaments and tendons.
The risk of developing the disease increases significantly with inadequate therapy, when at least one uncorrected anatomical defect remains in the ankle. For example, a displacement of the surfaces of the ankle elements by 0.1 cm changes the distribution of load on the entire joint. Cartilaginous and bone tissues begin to quickly wear out and wear out, which becomes the impetus for their destructive and degenerative changes.
Bilateral arthrosis.
Often, the occurrence of post-traumatic arthrosis results from prolonged immobilization of the limb during conservative treatment or after surgery. Immobilization is necessary for rapid healing of damaged tissue. But an excessively long absence of any physical activity provokes complications:
- deterioration of blood circulation;
- violation of venous-lymphatic outflow;
- muscle shortening;
- loss of elasticity in soft tissue structures.
In some cases, such changes may be irreversible. One of the types of post-traumatic pathology is arthrosis that occurs after surgery. Often, it is surgical intervention that allows maintaining the functional activity of the ankle. But it is always accompanied by tissue injury. Scars form in places where they are cut, disrupting blood circulation in the joint. In difficult cases, surgeons remove some elements of the articulation during surgery. And this violates the integrity of the surfaces and the relative position of the remaining structures.
Arthrosis of the ankle is most often detected in elderly patients. It becomes the result of slow metabolism and decreased production of collagen in the body. But post-traumatic arthrosis is more often diagnosed in young people and can cause loss of performance. The probability of developing pathology after an ankle injury is 20-60%.
Symptoms of the disease
At the initial stage of the pathology, symptoms appear weakly or are absent altogether. The victim does not always feel pain. Discomfort or swelling is not immediately detected.
But even minor injuries affect human health. The slightest damage affects capillaries and nerve fibers. The nutrition of joint tissues is weakened. Metabolic processes are disrupted.
After injury, the lower limb may hurt. A slight swelling appears. There is a feeling of discomfort when moving.
Such symptoms disappear quickly. The person believes that the danger has passed and the injury has healed. A necessary visit to the doctor is postponed indefinitely.
But after a few days, weeks or months, the disease may manifest itself. Post-traumatic processes have not stalled. They just slowed down.
When standing for a long time, the patient unknowingly twists his foot. The same movement occurs when walking. Increasingly, pain and discomfort are felt in the ankle joint.
Clinical picture
The first clinical manifestation of the pathology is pain, which intensifies when walking, especially when going up or down stairs. Post-traumatic arthritis is often accompanied by crepitus. This is the medical name for characteristic clicks and crunches during movement or flexion-extension of a joint. At rest there are no discomfort sensations. But another specific symptom of the pathology is “starting pain.” It occurs at the beginning of movement after a long rest in a sitting or lying position.
As destructive and degenerative changes in the ankle progress, the intensity of the pain syndrome increases. Other signs of joint damage also occur:
- aching pain disturbs a person at night or during sudden changes in weather;
- the range of motion in the ankle decreases, “stiffness” develops;
- swelling remains in the joint area, increasing in the morning;
- when palpating the joint, pain and uneven swelling are felt;
- the axis of the damaged limb is bent;
- The ankle deformity gradually worsens.
In the absence of medical intervention at the initial stage of post-traumatic arthrosis, it takes a relapsing course. Stages of remission alternate with painful relapses. Muscle contracture may develop, and reflex ankle spasms become chronic. The person avoids full support on the leg and begins to noticeably limp. With a disease of high severity, the joint loses mobility, dislocations, subluxations, ruptures of ligaments and tendons become common.
With exacerbations of post-traumatic arthrosis, synovitis often develops. The synovium becomes inflamed, and exudate accumulates in the joint cavity. This not only accelerates the progression of arthrosis, but also provokes symptoms of general intoxication of the body: fever, fever, indigestion, headaches.
Degrees and types of disease
The emergence and development of pathology is determined by 4 stages. At first, the changes are invisible. There is morning stiffness in the joints. Treatment needs to begin.
At the second stage, swelling is observed, and a crunching sound is heard when moving. The former mobility of the lower limb is limited. X-rays illustrate that the interarticular gap is decreasing. Morning stiffness lasts longer. Lameness may occur.
The third stage is characterized by the manifestation of deformation of the joints. The muscles atrophy. Movements are significantly limited. The ankle requires constant rest. But even with inactivity, pain is felt.
At the fourth stage, mobility is severely impaired. The joint gap almost disappears. X-ray shows noticeable proliferation of osteophytes. In such cases, only surgical treatment is used.
Doctors classify the following forms of post-traumatic arthrosis:
- Lightweight;
- Acute;
- Deforming.
Post-traumatic ankle arthrosis can develop slowly. The patient gets a chance to start treatment in a timely manner. Then the likelihood of slowing down the progression of the pathology increases.
Men aged 20 to 60 years are at risk of post-traumatic illness. Pathology among women occurs between the ages of 19 and 55 years.
Diagnostics
Before starting treatment for post-traumatic arthrosis of the ankle joint, a thorough examination of the patient is carried out. A rheumatologist, traumatologist or orthopedist makes a primary diagnosis based on symptoms and external examination of the injured ankle. Pathology allows us to assume the development of the disease by studying the anamnesis, which indicates a previous injury. The most informative diagnostic study is radiography. The resulting images clearly show dystrophic changes:
- the articular platform is deformed and changed;
- the joint space is narrowed, its contours are uneven;
- osteophytes (bone growths) and cyst-like formations have formed;
- the bone has hardened in the area under the articular cartilage.
If there is a need to assess the condition of any dense structure, a computed tomography scan is performed. To identify pathological changes in soft tissues, the patient is advised to undergo an MRI procedure.
In some cases, arthroscopy is prescribed—the insertion of a device equipped with a miniature video camera into the ankle cavity. During movement, it transmits an image to the screen, which allows the doctor to assess the degree of tissue damage and determine the number of complications that have developed. When performing arthroscopy, it is possible to collect exudate and even perform surgical procedures.
Definition of disease
The essence of the disease lies in the development of degenerative processes occurring in bone and cartilage tissues. Deforming external influence (traumatic injury) leads to a chronic form of the disease.
Degenerative-dystrophic changes affect the structure and shape:
- Hard tissues;
- Articular cartilage;
- Tendons;
- Blood vessels;
- Muscles;
- Nerves.
Injury leads to deformation and loss of tissue functionality.
Damage disrupts the structure of solid parts. Small cartilaginous elements break off. Even greater damage is caused to bone surfaces. The sensitivity of the receptors in the joint increases, and pain is felt.
After an injury, synovial fluid is not produced as intensively. Cartilage tissue is less well lubricated. Their food is becoming poorer.
As a result of the injury, the joint space narrows. This can lead to bone fusion.
In injuries with ligament ruptures, the tissue gradually scars. The rupture site becomes a focus of inflammatory processes.
Pathology develops in patients from different age groups. However, this form of arthrosis more often affects young, active and physically active people. The probability of post-traumatic arthrosis of the ankle ranges from 15% to 60%.
Basic therapy methods
The basic principles of treatment of post-traumatic arthrosis of the ankle joint are aimed at reducing the intensity of pain and increasing the functional activity of the ankle joint. A set of measures is also used to prevent further destruction of the joint. Physiotherapeutic procedures can enhance the healing properties of drugs. Typically, patients with post-traumatic arthrosis are prescribed 10-15 sessions:
- electrophoresis with novocaine, NSAIDs, chondroprotectors, analgesics, antispasmodics;
- thermal procedures with ozokerite, paraffin;
- phonophoresis;
- laser therapy;
- UHF therapy;
- shock wave therapy.
The drugs of first choice in the treatment of arthrosis are always local and systemic non-steroidal anti-inflammatory drugs. These are Voltaren and Fastum gels, Indomethacin ointment, tablets and injection solutions Diclofenac, Ortofen, Meloxicam, Ketorol. If NSAIDs do not have the necessary therapeutic effect, then the patient is prescribed glucocorticosteroids for therapeutic blockades - Hydrocortisone, Diprospan, Triamcinolone, Kenalog. Antispasmodics and muscle relaxants are used to eliminate muscle spasms.
| Physiotherapeutic procedures | Clinical effects |
| Shock wave therapy | Activation of metabolic processes, improvement of microcirculation in damaged tissues, reduction of pain severity |
| Thermal procedures with ozokerite, paraffin | Improving blood circulation, providing affected tissues with molecular oxygen, nutritional and bioactive compounds |
| UHF therapy | Reducing tissue swelling, accelerating the process of formation of primary bone callus and regeneration, eliminating muscle spasm |
| Laser therapy | Correction of cellular and humoral immunity, increasing the body’s non-selective resistance, enhancing microcirculation |
| Electrophoresis with novocaine | Reducing the intensity of pain and swelling of soft tissues located in the ankle area |
| Phonophoresis | Activation of blood supply and lymph outflow, implementation of the micromassage effect, acceleration of tissue regeneration, reduction of inflammation during synovitis, stimulation of collagen production |
Surgery is performed to restore the configuration and stability of the joint. During surgical intervention, osteotomy (artificial bone fracture) and osteosynthesis (reposition of bone fragments) are used. The joint structures are fastened and fixed with surgical metal structures - pins, knitting needles, nails, screws.
In some cases, it is impossible to restore the function of the joint even with surgery. Only complete replacement of the joint with an endoprosthesis or fixation of the ankle in a functionally advantageous position can help the patient. Rheumatologists warn that timely seeking medical help will help avoid surgical intervention.