Pathology of soft tissues of the ankle and foot area - diagnosis and treatment

The ankle joint, or, as it is popularly called, the ankle, is a joint that is an important element of the musculoskeletal system. Largely thanks to this joint, people can walk fully and straight and perform various maneuvers that the situation requires. The ankle joint ensures correct and rational distribution of the load on the foot area. Thanks to this, it can support the weight of the entire human body.

However, despite the high endurance of the joint, it is not always able to cope with loads. In this case, synovitis of the ankle joint develops.

What is synovitis of the ankle joint?

Several anatomical structures are involved in the formation of the ankle joint. Because of this, the articulation is usually classified as complex. Participating in the formation:

• three bones - little (lateral malleolus) - and tibia (medial malleolus), talus;
• articular ligaments that provide stability, capsule, synovium.

Naturally, only the harmonious work of all the constituent parts of the anatomical formation ensures the correct performance of its functions. However, in some cases the functionality is severely impaired. This happens, for example, with the development of synovitis of the ankle joint.

Synovitis of the ankle joint is an inflammatory process in the joint, which primarily affects the synovium.

Not all patients understand what inflammation of the synovial membrane is.
It's actually quite simple! The synovial membrane normally covers the joint on the inside. Thanks to it, normal metabolism is ensured in cartilage, which is deprived of its own vessels. The synovial membrane also secretes a special fluid, which is known as synovial fluid. The liquid acts as a shock absorber, reducing damage to anatomical structures due to friction. As soon as the synovial membrane becomes inflamed, fluid begins to be produced in larger volumes than necessary. As a result, the joint increases in size due to swelling, begins to hurt, and the patient experiences a pronounced limitation in the mobility of the joint.

What is synovitis? Causes, symptoms and treatment

The synovial membrane is located around ligaments and joints to protect them and increase mobility. It releases a special lubricating fluid that reduces friction and improves shock absorption during movement. As a result of injury or infection, the synovium can become inflamed. This leads to pain in the area of ​​the affected joint, restriction in movement (it seems that the joint has become difficult to bend). These signs may indicate that synovitis is developing.

Roman Sirotkin, a researcher at the Laboratory of Joint Pathology and Sports Trauma at the Republican Scientific and Practical Center for Traumatology and Orthopedics, told the information portal “Healthy People” about what synovitis is, its first symptoms, as well as the methods of diagnosing and treating the disease that are available to doctors.

Why does synovitis develop?

The synovium of a joint is made up of connective tissue and covers the entire joint. It is penetrated by nerves and vessels, the function of which is to ensure metabolism in the joint cavity and nourish the articular cartilage.

With synovitis, fluid accumulates in the cavity lined by the synovial membrane, the so-called inflammatory effusion - exudate. As a rule, the disease is limited to the boundaries of the affected area.

Roman Sirotkin: “Most often the cause of the disease is various pathologies or consequences of injury. Large joints are most susceptible to synovitis. For example, inflammation of the synovial membrane often occurs in the area of ​​the knee, hip and ankle joints. According to studies by various authors, the incidence of synovitis of the knee joint ranges from 9% to 33% of all its pathologies.”

There are several reasons for the development of the disease. Depending on the factor that became the root cause of the disease, synovitis of infectious and non-infectious etiology is distinguished.

Infectious synovitis. In this case, the provoking factor is an infection, the pathogen of which entered the cavity of the synovial membrane with blood or lymph.

Roman Sirotkin: “Synovitis can develop as a complication of a long-term purulent-inflammatory process (for example, with syphilis or tuberculosis). In addition, the infection can penetrate into the cavity of the synovial membrane as a result of injury if the integrity and impermeability of the joint has been compromised.”

Non-infectious synovitis . As a rule, they are a consequence of trauma to the synovium as a result of damage to a ligament or joint. Often diagnosed in athletes and those with hemophilia.

Synovitis can occur as a result of an infectious disease, as well as due to pathologies of the endocrine system (for example, in patients with diabetes).

Roman Sirotkin: “There are also neurogenic synovitis. The reason for their development is severe stress or neurological diseases.”

Main symptoms of synovitis

Typically, synovitis affects one joint. The development of the disease in several places at once is quite rare; as a rule, a similar picture is typical for systemic diseases, for example, rheumatoid arthritis.

Characteristic symptoms of the disease:

• swelling at the site of inflammation, the outlines of the joints are smoothed;
• with exertion – pain, movements are limited;
• sometimes body temperature rises;
• there is a feeling that the area of ​​the affected joint is “burning”;

If synovitis is infectious, the disease almost always starts acutely. The temperature rises sharply, pain and a feeling of fullness in the joint appear. After a few hours, the joint area swells, signs of intoxication appear: headache, feeling of weakness and anxiety, rarely vomiting.

Symptoms of non-infectious forms appear gradually, over several days, and largely depend on the cause of the disease. The first sign is discomfort in the joint and pain during movement or when putting stress on it. Then swelling appears, the joint becomes deformed, and the pain becomes stronger.

Diagnosis and treatment

The diagnosis of the disease is established based on the patient’s complaints and medical history, visual examination of the joint. If necessary, a joint puncture is performed to determine the causative agent of the disease, as well as ultrasound and MRI.

Roman Sirotkin: “As a rule, synovitis is a consequence of one or another disease or injury. Therefore, treatment is aimed mainly at identifying the causes, eliminating them, and also preventing chronicity of the process.”

Treatment of synovitis largely depends on the nature of the disease. If it is infectious, then therapy is aimed primarily at eliminating the source of infection. For non-infectious synovitis, treatment may be limited to immobilization of the limb using a plaster cast or orthosis for a period of up to 10 days. For more effective rehabilitation, physiotherapy is also prescribed. If synovitis is mild, the disease may go away on its own and without specific treatment.

Roman Sirotkin: “In some cases, a large amount of fluid accumulates in the synovial membrane (more than 20 ml), which the body cannot dispose of on its own. In such cases, using a puncture, it is removed from the joint to help the body cope with the disease.”

In case of chronic synovitis, the synovial membrane is surgically removed.

Complications of the disease may include limitation of range of motion and spread of the inflammatory process to other areas of the ligamentous apparatus.

The main methods of prevention are timely treatment of infectious diseases that can provoke inflammation of the synovial membrane, as well as compliance with precautions when playing sports aimed at preventing falls and injuries.

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Causes

Damage to the synovial membrane by the inflammatory process is a problem that not all people face during their lives. Doctors identify a number of factors that contribute to the development of the disease.

1. Injuries

Among the main reasons for the development of the disease are traumatization. Most often, synovitis is caused by sprains and ruptures of ligaments, and fractures in the ankle joint.

1. Birth defects

Often in the practice of an orthopedic traumatologist there are congenital defects that contribute to the development of the disease. This could be, for example, hallux valgus or flat feet. In this case, the load is distributed incorrectly, which leads to inflammation.

1. Diseases

Osteochondropathy of the talus. As a result, the articular surfaces are deformed, and a free osteochondral articular fragment may form. The above factors cause synovitis.

1. Shoes

Incorrectly chosen shoes can contribute to the development of symptoms of synovitis. For this reason, the disease affects women who are forced to wear high-heeled shoes, due to which the load on the ankle joint is very high.

1. High physical activity

Another important factor is intense physical activity. The joint does not have an infinite reserve of strength, and sooner or later its functionality begins to decline, which leads to the appearance of unpleasant symptoms.

Basic principles of treatment

Treatment of synovitis of the ankle joint quickly produces results when its cause is eliminated and the provoking factor is eliminated from the usual lifestyle. In some diseases, the accumulation of exudate can only be prevented. In osteoarthritis, gout, rheumatoid and psoriatic arthritis, synovitis takes a chronic course. Each type of pathology requires certain treatment methods and specific pharmacological drugs.

Traumatic synovitis

At the initial stage of therapy, surgical intervention is performed, which depends on the type of injury. In case of open fractures, it is necessary to restore the normal position of the bones, suturing the damaged ligaments, joint capsule, and skin. Closed and open articular fractures require “skeletal traction” with the installation of pins and hanging a load to prevent relapse.

Pott's fracture.

The rehabilitation period lasts several weeks, so treatment for synovitis begins without waiting for bone fusion or tendon regeneration. The first choice drugs are non-steroidal anti-inflammatory drugs with the following active ingredients:

• nimesulide;
• diclofenac;
• ibuprofen;
• ketoprofen;
• meloxicam;
• piroxicam;
• indomethacin;
• ketoprofen.

Anton Epifanov on the use of NSAIDs:

The simultaneous oral administration of proton pump inhibitors - Omeprazole, Pantoprazole, Esomeprazole - helps to prevent and eliminate their side effects. When performing magnetic therapy at the traction stage, the healing of damaged tissues is accelerated. This physiotherapeutic procedure has a pronounced anti-inflammatory effect, allowing you to eliminate the symptoms of synovitis. When the ankle swells, surgeons pump out the accumulated effusion using a puncture.

Acute infectious synovitis

Pathology therapy begins immediately with a puncture. Excess fluid with pus and pathogenic bacteria has accumulated inside the joint cavity, quickly destroying connective tissue. The skin over the ankle is treated with ethyl alcohol and iodine solution, and local anesthesia is performed. For anesthesia, 2% solutions of Novocaine or Lidocaine are used. After the puncture, the exudate is pumped out, and the joint cavity is washed several times with antiseptic solutions until clear liquid comes out. A patient with infectious synovitis is advised to take the following antibacterial drugs:

• macrolides - Clarithromycin, Azithromycin;
• semisynthetic protected penicillins - Amoxiclav, Panclave, Flemoclav.

For specific infectious synovitis, antimicrobial agents and sulfonamides are also prescribed. Along with antibiotics, the patient takes non-steroidal anti-inflammatory drugs in the form of tablets or intramuscular injections.

After antibiotic therapy, intestinal dysbiosis often develops. To restore beneficial microflora, a course of probiotics and prebiotics is recommended - Lactobacterin, Bifidumbacterin, Enterol, Duphalac, Acipol.

Psoriatic and rheumatoid arthritis

Synovitis that develops against the background of autoimmune diseases is treated together with the underlying pathology. At the initial stage of the disease, anti-inflammatory drugs and proton pump inhibitors are used. If they are insufficiently effective, glucocorticosteroids are included in the therapeutic regimen:

• Prednisolone;
• Dexamethasone;
• Hydrocortisone.

After stopping the inflammatory process and reducing the intensity of symptoms, the patient is recommended to take a long-term course of chondroprotectors - Artra, Teraflex, Structum, Glucosamine-Maximum, Chondroitin-Acos. For pain relief, 5-10 courses of physiotherapy are prescribed: magnetic therapy, UHF therapy, diathermic currents. During treatment, you need to use fixing bandages, a cane, and, if necessary, crutches.

Anton Epifanov and the principles of physiotherapy:

When treating pathology, it is possible to combine systemic and local NSAIDs. The use of ointments, creams and gels allows you to reduce the dosage of tablets and injections and minimize adverse reactions. Voltaren, Fastum, Artrosilen, Diclovit, Ketorol have proven themselves well in therapy.

Self-medication will cause the progression of destructive-degenerative changes in the ankle and deterioration of the patient’s well-being. For adequate therapy, a thorough preliminary examination of the patient is necessary. Only establishing the cause of the pathology will help select drugs to accelerate the regeneration of tissues affected by inflammation and for a person’s recovery.

Types of synovitis of the ankle joint

Like any other ailment, the inflammatory process in the ankle joint is divided into several types.

The first classification is based on the severity of symptoms and the rate of fluid accumulation. There are acute and chronic pathologies. In the first case, liquid accumulates due to some negative impact in a short period of time. The symptoms in this case are pronounced and difficult to ignore.

In the second case, fluid accumulates slowly in the joint cavity. As a result, symptoms can either be mild or develop progressively. The chronic disease occurs in waves: periods of remission are replaced by exacerbations with quite pronounced symptoms.

The second classification is based on the reason that served as the impetus for the development of the inflammatory process. Highlight:

• an infectious form that develops due to the entry of pathological microorganisms into the joint cavity and is accompanied by symptoms of general intoxication, malaise, and weakness;
• the trophic form, which is mainly found in patients who suffer from decompensated diabetes mellitus for a long time without taking the disease under control, is characterized primarily by impaired blood supply with the subsequent development of inflammation;
• traumatic (post-traumatic) form, which develops due to improper treatment of joint injury (the duration of injury for the development of synovitis is not decisive; the joint suffers, even if the injury occurred years ago);
• autoimmune form, which is a consequence of aggression of a person’s own immunity on joint tissues (in the ankle area it is rare, but it cannot be excluded), etc.

Additionally, to classify the disease, an assessment of the composition of the joint fluid is used. The disease can be fibrinous, serous, purulent or hemorrhagic.

Symptoms of synovitis

Synovitis primarily affects one joint, but sometimes the inflammation affects several joints.

Symptoms of acute synovitis of the knee joint are severe pain in the affected area and swelling. The pain may increase with palpation. The shape of the joint changes due to the accumulation of serous exudate in its cavity. There is a decrease in its mobility, weakening of the ligamentous apparatus, which can lead to instability of the joint.

In the case of infectious synovitis, local signs of inflammation appear, which are expressed by hyperemia of the surface area of ​​the skin of the diseased joint, and a local increase in temperature is also observed.

In the case of acute primary synovitis, serous fluid accumulates in the joint cavity, but if a pyogenic infection occurs, then purulent bodies appear in the serous exudate. As a result, the ends of the bones are involved in the purulent process along with the soft tissues of the joint.

In such cases, signs of general intoxication appear. The temperature rises, chills, severe pain in the joints and weakness appear. The connective tissue begins to wrinkle and scar. This then affects the mobility of the joint.

Chronic synovitis of the knee joint is characterized by a less pronounced aching pain, but of a constant nature. Swelling increases, and all metabolic processes and blood circulation are disrupted. This can lead to instability of the joint, which can lead to dislocation, curvature and complete immobility of the joint.

Symptoms

The signs of the disease, regardless of its origin, are the same. True, they can appear at different time intervals. Symptoms characteristic of synovitis are:

• increased fatigue under loads that a person could previously easily cope with;
• feeling of discomfort in the problem area;
• pain localized in the ankle area, which can affect surrounding tissues with severe swelling;
• redness and swelling of the area involved in the pathological process;
• an increase in temperature and the appearance of symptoms of general intoxication (with an infectious form) are possible.

The severity of symptoms depends on the stage of the disease. The first alarm bell is always pain, which initially appears only when performing rotational movements. Gradually, the pain increases so much that it accompanies the patient even at rest, disrupting sleep and normal functioning in general.

Diagnostics

Synovitis of the ankle joint does not begin to be treated until the diagnosis is confirmed. The following diagnostic methods are used in combination, which allows you to make an accurate diagnosis and eliminate errors:

1. Visual assessment

Inspection of the joint is a mandatory stage of the diagnostic search. Moreover, it is assessed not only at rest, but also in motion. For example, when walking or performing any simple actions.

1. Instrumental techniques

Sometimes the swelling of the surrounding tissues is so severe that it becomes difficult to evaluate the joint. In this case, ultrasound, MRI, and radiography are used as auxiliary measures.

MRI of the ankle

1. Performing a puncture

The method of obtaining intra-articular fluid is not only diagnostic, but also therapeutic. On the one hand, the doctor can evaluate the bacterial composition of the synovial fluid and identify the infectious agent, if any. On the other hand, excess fluid that interferes with normal functioning is removed from the joint cavity, which alleviates the symptoms of the disease.

Only after the doctor is confident in the diagnosis will he begin to choose the optimal treatment.

Conservative therapy

In the treatment of synovitis of the ankle joint, it is first necessary to try to stop the pathological condition using conservative techniques. For this:

• the patient is taught to properly fix the affected joint to reduce the load;
• carry out physiotherapeutic measures that will help relieve inflammation and improve regeneration processes;
• select medications that can relieve pain and eliminate swelling of the affected area;
• after the onset of stable remission, courses of physical therapy are recommended to improve joint mobility and prevent relapses of the disease.

Puncture of joint fluid can also be part of conservative therapy. By removing excess fluid, the functionality of the joint can be improved. However, puncture is a measure that gives only temporary results. Treatment in any case should be aimed at eliminating the causes of the pathology. For example, it may be necessary to clear up an infection with antibiotics or fight an autoimmune process.

Why is synovitis dangerous?

The practice of the Canon clinic shows that in winter the number of bruises, dislocations, and bone fractures associated with falls increases significantly. Often, against the background of these injuries, victims develop a joint disease - synovitis.

Synovitis

is an inflammation of the synovial membrane lining the inside of the joint cavity. It produces a sticky transparent liquid, the importance of which is difficult to overestimate. Firstly, this fluid nourishes the cartilage tissue of the bones entering the joint, and secondly, it acts as a lubricant, allowing the rubbing cartilaginous surfaces of the bones to slide when performing movements. When inflammation occurs in the synovium, fluid production increases, making it difficult for the joint to function. Depending on the cause of the disease, the fluid may also be purulent or hemorrhagic (mixed with blood) in nature. Along with its accumulation in the joint cavity, pain appears and swelling develops.

Among the reasons leading to the development of synovitis, one should first of all note injuries - bruises, sprains, ruptures of the capsule (connective membrane of the joint) and ligaments, intra-articular fractures, as well as heredity. In addition, inflammation of the synovium can be caused by infection. Thus, pathogens enter the joint through the bloodstream from acute and chronic foci of inflammation in the body, especially in people with a weakened immune system. By the way, risk factors include various diseases, such as tuberculosis and intestinal infections. To the list of reasons should be added such a chronic joint disease as deforming arthrosis, and, of course, rheumatism, since synovitis is an obligatory component of rheumatic damage to the body.

Synovitis

- a fairly common disease that occurs in adults and children in different age groups. According to statistics, with this disease, in approximately 65–70% of cases, the knee joint is affected, and much less often the shoulder, ankle, and hip joints.

Symptoms of inflammation of the synovial membrane:

• pain that gets worse with movement;
• swelling, in which the joint may swell like a ball and be hot to the touch;
• the presence of an excessive amount of defective intra-articular fluid;
• increased body temperature;
• limited mobility of the affected joint.

There are acute and chronic synovitis.

The first of them is the most common; it often occurs suddenly and, with timely treatment, goes away in about three weeks.

A chronic process is the result of a protracted course of an acute one and occurs with frequent exacerbations. When acute inflammation is complicated by infection in the synovial membrane, purulent synovitis develops, which is manifested by a deterioration in the general condition and aggravation of local symptoms.

Diagnosis of the disease

– X-ray and ultrasound examinations, computer and magnetic resonance imaging. If necessary, the patient undergoes a puncture to extract and subsequently examine the synovial fluid.

It should be emphasized that self-medication, which some patients resort to, can only aggravate the disease and lead to serious complications in the future. These include, in particular, a decrease in joint mobility, the occurrence of a purulent process in it, which can spread in the body and cause sepsis (blood poisoning). To prevent the development of complications, it is necessary to consult a traumatologist when the first symptoms of the disease appear.

You can make an appointment by calling the clinic +7 (351) 217-52-62

Based on the results of diagnostic studies, he will make an accurate diagnosis and prescribe appropriate treatment.

It is usually conservative and consists of the use of anti-inflammatory drugs, and, if necessary, hormonal drugs. A plaster splint is placed on the affected joint for one to two weeks to limit mobility. When the inflammatory process subsides, the patient is shown physiotherapeutic procedures and physical therapy. The duration of treatment for acute synovitis and exacerbation of the chronic process is three to four weeks. And full recovery of the affected joint occurs no earlier than after two to three months. But in severe cases, surgical intervention is resorted to.

Prevention of synovitis

- This is, first of all, a healthy lifestyle, balanced nutrition and exercise and sports, but without excessive stress on the joints. In addition, it is necessary to control body weight, since exceeding it negatively affects the condition of the musculoskeletal system, and this is fraught with various ailments. Finally, it is very important to promptly treat infectious diseases and follow your doctor’s recommendations to strengthen your immune system.