Degenerative destruction of arthrosis of the talonavicular joint

Arthrosis of the talonavicular joint is a degenerative pathology in which gradual destruction of articular tissues is noted, with changes in bone surfaces. When the disease occurs, the cartilage of the joint becomes thinner, its rubbing surfaces lose their ability to slide, and the ligaments lose their elasticity and become less strong. Deforming arthrosis is often a consequence of ankle injuries, and less often it has a congenital form.

With pathology, microscopic tears occur in the tissues of the joint, which provoke not only the appearance of acute pain and inflammation, but also a gradual limitation of the mobility of the limb. Young athletes, football players and dancers are more often susceptible to joint damage, when the process of bone growth is still ongoing and unformed limbs are exposed to excessive stress, as well as bruises and sprains.

Degrees of development

Less commonly, the disease is caused by congenital abnormalities that develop against the background of a severe form of dysplasia of the joints of the lower extremities. The initial stage of arthrosis occurs almost unnoticed and is determined exclusively by x-rays. However, as it progresses, the pathology begins to manifest itself with unpleasant symptoms.

As clinical manifestations arise, arthrosis of the subtalar joint has three stages of development.

1. The first stage is characterized by minor pain in the heel of the foot, as well as fatigue after prolonged stress on the limb. The first warning sign of the disease is the presence of discomfort in the foot during long walks, which goes away on its own after rest. At this stage of pathology development, x-rays usually show the presence of sclerosis of the subhodral bone and the appearance of osteophytes (growths) on the bone surface.
2. At the second stage of disease progression, the head of the metatarsal bone becomes denser, contributing to minor restrictions on the mobility of the joint. At this stage, the patient regularly experiences pain during and after walking, which can be relieved by keeping the limb in a state of complete rest for a long time. Frequent inflammation of the talocalcaneal joint and pain on palpation is a reason to consult a doctor. Since the second degree of arthrosis eventually limits the normal mobility of the affected limb.
3. The third degree of pathology does not go unnoticed. It is characterized by significant deformation of the joint, in which the big toe is almost immobilized and falls down. The pain becomes very difficult to endure, since it does not stop even at rest. Its irradiation is so extensive that sometimes the pain also affects the knee joint. At this stage, the cartilage tissue undergoes complete destruction, a narrowing of the lumen is observed between the bones of the joint, and the disease becomes chronic.

If the patient consults a doctor at an early stage of the development of the pathological process and timely conservative therapy is carried out, deformation of the talonavicular joint can be significantly slowed down and sometimes completely prevented.

general characteristics

This joint got its name because of its location. The talocalcaneal navicular joint is the union of the talus, calcaneus, and navicular bones.

The location of the talus is the calcaneus and the distal end of the tibia. To put it differently, it represents a kind of meniscus. Its body and head are enclosed in a neck. The calcaneus, flattened laterally and elongated in shape, is concentrated in the posterior-inferior zone of the tarsus. It has the largest size in the entire foot. The bony structure contains two articular blocks for articulation with the cuboid and talus bones. And finally, the navicular - located inside the foot. It has a lumpy inner edge, which determines the height of the foot. The posterior articular block connects to the talus.

The entire talocalcaneal joint has a spherical shape, which provides it with sufficient functionality in connection with the subtalar joint. Combined mobility is formed inside the foot, allowing it to rotate around its own axis. The strength of the bone connection is ensured by the powerful interosseous talocalcaneal ligament.

Causes

The disease often begins to actively progress after 20 years, against the background of existing flat feet. And since the growth of bone tissue during this period is not yet complete, any external factors can contribute to the development of pathology.

The most common causes of arthrosis of the talocalcaneal joint are usually:

• Limb injury. Any dislocation, severe bruise, fracture or sprain of the ankle leads to irreversible consequences.
• A prolonged inflammatory process in the body often causes the manifestation of rheumatoid arthritis.
• Excess weight is another obvious reason. To avoid joint problems, it is important to learn to control your weight and lead an active lifestyle.
• Dysplasia refers to congenital joint pathology. Their improper formation in the mother's womb leads to problems with cartilage tissue. It does not become elastic, which subsequently causes bone deformation and rapid wear.
• Impaired metabolism often provokes the appearance of arthrosis of the limbs. Due to metabolic disorders, the usual nutrition of the synoval membrane and cartilage tissue deteriorates, which significantly increases the risk of developing pathological processes in the joints.

Postoperative rehabilitation

The action plan for joint restoration after surgery is individual. A day later, when the patient has completely recovered from anesthesia, he will be prescribed a course of antibiotics. This minimizes the risk of developing postoperative complications.

During the first weeks after surgery, the foot and ankle should be securely immobilized with a plaster splint. It cannot be removed earlier, so as not to disrupt the process of formation of the periosteum and not to delay healing. To avoid swelling of the soft tissues, the leg should be in an elevated position at all times. In the first two weeks, the patient is recommended to rest; under no circumstances should the foot be loaded. At the end of this period, the patient will undergo the first dressing, and the condition of the wound and tissues will be assessed.

Over the next one and a half to two months, the tendon should be securely fixed with a rigid bandage. It is still prohibited to put any weight on it, but you can take short walks with a cane or crutches). If pain is felt in the leg, the rest period should be extended.

After 2 months, the person is given a control x-ray and, if the healing process is going well, the bandage is removed and replaced with an orthopedic boot. With it, the operated joint can be loaded little by little, but it will be reliably protected from overload. Control photographs are taken every month. Starting from the third month, the doctor will allow you to engage in physical therapy. You should not neglect the set of exercises: exercises will restore activity and correct the problem with lameness that has developed after an illness.

After radical treatment, the patient can begin work after 2 months, but provided that his work does not involve heavy physical exertion. Athletes, dancers and people who experience increased physical activity due to their duties can return to their usual activities only after a doctor’s permission.

Manifestation of symptoms

Symptoms of arthrosis of the talonavicular joint directly depend on the degree of damage. They can be divided into basic: pronounced and additional. As the disease progresses, the patient experiences:

1. Swelling affecting the area from the foot to the ankle;
2. Stiffness of the limbs;
3. Inflammatory processes in muscles and joints;
4. Pain when straightening or flexing the foot;
5. Sharp pain in ankle.

Deformation of cartilage tissue occurs gradually and the greater the degree of damage, the stronger the impact on the joints. When absolute destruction of cartilage occurs, the body tries to compensate for the problem by growing bone formations, which becomes the main cause of loss of motor function.

Manifestations of deforming arthrosis of the talonavicular joint are often pain that occurs during movement on any uneven surfaces. The greater the degree of damage, the more painful it is for the patient to walk on uneven surfaces.

Arthrosis of the metatarsophalangeal joints: what is it?

The metatarsophalangeal joints are ball and socket joints. They are formed by the articular surfaces of the heads of the metatarsal bones and the bases of the proximal phalanges. The ends of the bones that form the joint are covered with thin cartilage tissue. The articular capsules are attached along the edge of the articular cartilages and are thinned on the outside of the foot. On the opposite edge and sides they are strengthened by plantar and collateral ligaments, respectively. In this case, between the heads of the metatarsal bones there is a deep transverse metatarsal ligament.

The structural features of the metatarsophalangeal joints make them susceptible to the development of degenerative-dystrophic changes (arthrosis) and inflammatory processes (arthritis). Moreover, arthrosis is often complicated over time by the development of arthritis. This significantly worsens the well-being of patients.

Arthrosis is called damage to the cartilage tissue covering the heads of the metatarsal bones and the bases of the proximal phalanges of varying degrees of severity. Initially, the cartilage becomes dehydrated and thins, becoming covered with microscopic cracks. But gradually, under the influence of loads or other factors, they increase in size and take on the appearance of large cracks and depressions. This leads to a decrease in the size of the joint space, which causes difficulties in movement and prevents the free sliding of the heads of the bones.

As a result, there is an increase in load and increased friction between bone surfaces. This is accompanied by the formation of osteophytes on them, i.e. bone growths. They may have sharp edges that will injure surrounding tissues and the joint capsule. As a result, over time, arthrosis of the metatarsophalangeal joints can be complicated by arthritis, that is, the addition of an inflammatory process.

Most often, arthrosis affects the metatarsophalangeal joint of the 1st toe or big toe. In this case, hallux rigidus is diagnosed. It is somewhat less common to diagnose arthrosis of the joint of the 2nd finger and extremely rarely of the others. This is due to the fact that the first finger bears the main load when walking, standing and physical activity.

The main danger of the disease is the occurrence of severe deformities of the joints, which will lead to a significant decrease or even complete loss of their functionality. As a result, patients may experience difficulty moving, even to the point of losing the supporting ability of the foot. The risk of local circulatory disorders also increases sharply. This increases the likelihood of developing varicose veins of the lower extremities.

Diagnostics

Visually diagnosing disease of the talonavicular joint at an early stage is almost impossible. In rare cases, minor pain while walking prompts the patient to contact a medical facility to identify the causes of the discomfort.

A clear picture specific to arthrosis of the talonavicular joint can be obtained during an X-ray examination. The image clearly shows the clinical manifestations of the pathology: hyperplasia, as well as curvature of bone tissue, the presence of a cyst and narrowing of the joint spaces. If you listen to the recommendations of your doctor and follow the chosen treatment method, it is quite easy to stop changes in the joint at this stage of progression.

Treatment

To combat the pathology of the talonavicular joint, complex therapy is used, including:

• Wearing orthopedic devices;
• Drug therapy;
• Physiotherapy;
• Maintaining proper nutrition;
• Unconventional methods of influence;
• Exercise therapy.

Conservative treatment, when a patient goes to a medical facility at an advanced stage of the disease, will be unsuccessful. Therefore, surgical manipulations are unlikely to be avoided.

To combat the symptoms of this pathology in medical practice, drugs of various effects are used. For example, to successfully suppress inflammatory processes in the body and relieve pain, NSAIDs are used. Muscle relaxants help relax the muscles of the joint and also fight spasms caused by pain.

Nonsteroidal drugs

Drug therapy offered by conservative medicine includes direct injection into the diseased joint, as well as intramuscular injections, a course of pills and rubbing in anti-inflammatory ointments.

Before prescribing treatment, the doctor is obliged to examine the patient to identify possible chronic diseases and assess overall health. Because, despite the obvious effect of the pharmacological drugs used, they, without exception, negatively affect the health of other organs and systems of the human body.

In addition, most of the steroid and non-steroidal drugs, the purpose of which is to defeat arthrosis of the talonavicular joint, aggravate the course of the disease, destroying the cartilage. As a rule, a regular injection of this drug will help the patient get rid of severe pain, but at the same time it will accelerate the destructive processes of cartilage tissue, thereby only complicating the course of the disease.

Chondroprotectors

If, during the treatment of arthrosis of the joint, damage to cartilage tissue is observed, it is advisable to use chondroprotectors, the basis of which is glucosamine and chondroitin sulfate - the main components of cartilage tissue. Their main task is to protect and restore cartilage. In combination with anti-inflammatory drugs, in the initial form of development of the pathology, the drugs can relieve the patient of disturbing symptoms.

At the second stage, drugs slow down the destruction of cartilage and block the development of degenerative processes in the joints. The main active components of chondroprotectors are chondroitin and glycosaminoglycan. The medications are usually used in courses of one to six months. The most popular chondroprotectors include:

• Alflutop;
• Artra;
• Structum;
• Teraflex;
• Dona et al.

Alflutop

Artra

Structum

Teraflex

Since the effectiveness of drugs based on animal bones and tissues has not been confirmed by clinical trials, therapy with their use can only be called conditionally useful. The therapeutic effect of chondroprotectors sometimes appears only after six months. And if there are no visible improvements, their use is considered inappropriate.

In addition to tablet forms, local medications are used to treat arthrosis. Ointments and creams have a quick anti-inflammatory effect, the most popular among them are Fastum-gel and Finalgon.

To ensure that the patient’s muscles, which remain motionless for a long time, do not atrophy, a course of health-improving physical education is mandatory. Exercises increase the mobility of the foot, strengthen the ligaments, while reducing the load on the joint and pain.

How to treat arthrosis deformans

Treatment for arthrosis deformans is aimed at relieving pain and swelling, as well as regenerating damaged synovial cartilage and returning the patient to normal life.

For this, it is recommended to take anti-inflammatory and chondroprotective drugs, therapeutic exercises and diet, massage, manual therapy, as well as wearing fixing bandages and bandages that reduce the risk of joint injury (especially if the patient suffers from hypermobility of damaged joints). Which doctor treats arthrosis deformans? For a list of prescriptions, you should contact an orthopedist-traumatologist, but you may also need consultations with other specialists - for example, an endocrinologist, rheumatologist, or surgeon.

Medicines in the treatment of deforming arthrosis in the later stages are ineffective. Advanced disease may be an indication for surgery. In these cases, depending on the condition, the following is required:

• arthrotomy;
• resection of the shoulder joint;
• endoprosthetics (hemiarthroplasty, total arthroplasty).

Physiotherapy

Physiotherapy for deforming arthrosis of the joints is aimed at improving blood circulation and metabolism, accelerating the regeneration of cartilage tissue, eliminating pain and inflammation and maintaining the function of muscles and ligaments. For this purpose, the following methods are used:

• electrophoresis;
• magnetic therapy;
• laser therapy;
• galvanization;
• oxygen therapy;
• electromyostimulation;
• ultrasound therapy;
• diadynamic therapy;
• acupuncture;
• shock wave therapy;
• paraffin therapy, ozokerite, compresses;
• massage;
• mud therapy, turpentine baths.

Massage for deforming arthrosis

Massage for deforming arthrosis of joints helps relieve muscle spasm, improve nutrition of joint structures, and fights atrophy of muscles and ligaments that support worn-out joints. Massage helps restore innervation and reduce pain, destroy endomysial adhesions that form from inactivity of the affected joint.

For both therapeutic and self-massage, three types of movements are used (the order is followed):

• warming (circular, light pats, stroking);
• stretching (along the muscles);
• kneading (deep impact by kneading, squeezing).

Massage is carried out not only directly over the joint - in order to improve metabolism and compensatory muscle function, it is important to massage adjacent parts of the body. If the joint is affected on only one side (for example, the left knee), the other is also subjected to massage.

Avoid pain during massage - the effect should be gentle and increase gradually.

If the procedure is carried out once a day, it should last at least 15-25 minutes, if 2-3 times - no more than 10 minutes. Always end the session with stroking and warming up. The first effect will occur after 2-3 sessions.

Exercise therapy

For deforming arthrosis of the joints, exercise therapy pursues several goals, such as: relieving pain and discomfort, strengthening muscles and blood vessels, maintaining and restoring mobility in the joint, improving metabolic processes, consolidating remission and improving the general psycho-emotional state of the patient.

The list of exercises is individual for deforming arthrosis of various localizations. The list below contributes to overall muscle strengthening and can be supplemented as prescribed by a doctor:

1. Sit on a chair and clasp your hands at the back of your head. Bend back as far as you can, resting your shoulder blades on the back of the chair. 5 approaches.
2. Lying on your back, hands folded under the back of your head, legs bent, feet on the floor. Tighten your back and abdominal muscles and hold for a few seconds.
3. Lying on your back, bring your half-bent legs together. Alternately tilt them to the left and then to the right, so that the outer side of the thigh lies completely on the floor.
4. Sitting on a chair, place your palms under you, as if holding yourself by the back of your thighs. Gradually bring your shoulder blades together as much as possible.
5. Lying on your back, raise your head, looking ahead parallel to the position of your body. Hold for 10 seconds, then rest for five and repeat. Up to 8 times.
6. Slowly move your head back, trying to touch the back of your head and stay for a few seconds at the end point. At the same time, you should feel a static load. 10 times.

Alternative therapy

Non-traditional types of treatment for arthrosis of the talonavicular joint include various procedures, including:

1. Apitherapy;
2. Phytotherapy;
3. Hirudotherapy;
4. Mud baths;
5. Acupuncture;
6. Traditional medicine.

A big plus in treating a disease with traditional medicine recipes is the almost absolute harmlessness of the components used, as well as strengthening the immune system and the body as a whole.

No less popular in the treatment of pathology are bees and leeches. Stings promote active blood circulation in the vessels, which significantly increases the nutrition of tissues, cartilage and joints. At the same time, the patient’s body receives irreplaceable natural elements that have a positive effect on the ankle joints.

ethnoscience

You can resort to traditional medicine recipes only after consultation with your doctor. The action of such methods is aimed at eliminating swelling and pain.

The following recipes show excellent results:

1. Garlic compresses, mixed with vegetable oil and applied to the affected joint before bed.
2. Ointment made from St. John's wort and hops. You will need 10 grams of each herb. They need to be ground, add about 50 grams of Vaseline oil and after a day of infusion, apply twice a day.
3. Using fir oil, you can make a warm compress or rub the product directly into the affected area.
4. Potato compresses are effective. The pulp of the tubers must be crushed, the resulting mass must be soaked in warm water for several hours and applied to the inflamed joint twice a day.

Traditional methods of treatment should not be considered as the main ones. They are an excellent addition to exercise therapy, massage and drug therapy. With the help of such folk remedies, you can achieve stable remission and eliminate unpleasant pain.

Prevention

Preventive measures for arthrosis of the talonavicular joint include:

• Nutrition and weight control. Excess weight is the first enemy of joints;
• Try not to overuse salt and calcium supplements;
• If possible, do basic morning exercises;
• Take vitamin and mineral complexes regularly.

Don't skimp on shoes. It should not be tight, large, narrow or uncomfortable. Women are not recommended to wear high heels every day. Children should never buy shoes to grow as they grow, as this can lead to foot deformation in early childhood.

If your job
requires you to stand or walk for a long time, take breaks. This is necessary so that the muscles of your legs can not only rest, but also recover. If leg pain becomes regular, do not delay visiting your doctor.