Why does ankle cartilage wear out?
The ankle joint is designed in such a way that its cartilage is very resistant to stress: it is thinner, but denser than in the knee. Therefore, primary age-related arthrosis is rare here. The main mechanism is post-traumatic: after an ankle fracture, even a slight displacement of the articular surfaces changes the distribution of pressure, and the cartilage in the overloaded area is destroyed. Repeated sprains lead to instability: the foot regularly rolls in, and each episode damages the cartilage. Foot deformations make their contribution, in which the load is constantly shifted to one side.
- Post-traumatic arthrosis is the most common form
- Instability after repeated sprains
- Deformities of the foot and shin axis
- Secondary arthrosis in rheumatic diseases
- Consequences of aseptic necrosis of the talus
- Primary arthrosis without a cause is rare
Causes and risk factors
The main factor is a previous fracture in the ankle area, especially if the fragments have fused with displacement. The second most important is long-standing instability after ruptures of the external ligaments, when a person twists his leg for years. Wear is accelerated by excess weight, work involving long periods of standing and walking on hard surfaces, and uncomfortable shoes with high heels or completely flat soles. A separate group consists of rheumatoid arthritis, gout and hemophilia, in which the joint is damaged from the inside by inflammation or hemorrhage.
- Ankle fracture, especially displaced
- Repeated sprains and instability
- Excess body weight
- Flat feet and other foot deformities
- Working on your feet, walking on hard surfaces
- Rheumatoid arthritis and gout
- Professional sports with high impact loads
Symptoms
At first, the pain appears only after a long walk or exercise and goes away overnight. Gradually it appears at the beginning of movement - starting pain, when the first steps after sitting are difficult, and then the joint moves around. By evening, the ankle swells and the shoes become tight. There is a crunching sensation, a feeling of stiffness in the morning for several minutes, difficulty walking up stairs and on uneven surfaces. With severe arthrosis, the range of movements noticeably decreases, the gait changes, and the load is redistributed to the knee and lower back.
- Pain after walking, later and at rest
- Starting pain after rest
- Swelling of the ankle in the evening
- Crunching sound when moving
- Morning stiffness for a few minutes
- Limitation of flexion and extension of the foot
- Changes in gait and lameness
Diagnostics
The doctor examines the foot and lower leg, assesses the axis of the limb, range of motion, stability of the ligaments and the place of greatest pain, and asks about previous injuries. The main method is x-ray in two projections, if necessary with a load in a standing position: it shows narrowing of the joint space, bone growths, bone sclerosis and deformation. Ultrasound reveals fluid and tendon changes; MRI is needed if damage to cartilage, ligaments, or necrosis of the talus is suspected. Blood tests are prescribed if there is a suspicion of an inflammatory or metabolic disease.
- Inspection with assessment of axis and stability
- X-ray of the ankle joint in two projections
- Stress x-ray if instability is suspected
- Ultrasound of the joint and tendons
- MRI for cartilage and ligament damage
- Complete blood count, ESR, C-reactive protein
- Uric acid for suspected gout
Treatment and prevention of exacerbations
The goal is to relieve excess stress and maintain mobility. Weight loss, comfortable shoes with shock-absorbing soles and low heels, individual insoles, and, if unstable, an orthosis or taping help. Physical therapy strengthens the calf muscles and trains balance, which reduces the risk of new sprains. During the period of exacerbation, non-steroidal anti-inflammatory drugs are used in a short course, local remedies, and physiotherapy. For severe joint destruction, surgical options are discussed, including corrective surgery, arthrodesis, and arthroplasty.
- Weight loss
- Shoes with shock absorption and a stable heel counter
- Custom orthopedic insoles
- Orthosis or taping for instability
- Calf Strength and Balance Exercises
- Short course anti-inflammatory drugs
- Physiotherapy during remission
- Surgical treatment for severe arthrosis