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ankle arthritis

Introduction / Definition

Osteoarthritis (joint wear) of the ankle describes a degenerative (wear-related) change in the upper ankle, which usually occurs after a previous illness or through overloading. Due to the heavy load on the upper ankle joint, osteoarthritis is a very common disease, which can be treated very well conservatively at the beginning.

ICD / GdB

The ICD classification is the so-called "International Statistical Classification of Diseases and Related Health Problems". It serves the classification of health impairments in the health system and is used among others in Germany. Each disease is assigned its own number and number combination in the ICD classification. The ankle osteoarthritis is found under the umbrella term of "other arthrosis" again and is in particular numbered with M19.07.

GdB stands for "degree of disability" and describes the classification of the impairment, which can be caused by different diseases. The staggering takes place on a table up to 100 in steps of ten. Depending on the extent of the impairment, different numbers of points are attributed. A value of 50 and above is a severe disability. Ankle osteoarthritis may cause a GdB of 0 to 40, depending on the extent of the disease and individual impairment. The GdB is determined by a medical expert.

Structure / pathogenesis

The upper ankle joint consists of three communicating joint surfaces:

  • The end of the fibula ( fibula ),
  • End of the tibia ( tibia )
  • and the talus.

To ensure that these bone ends do not rub against each other without protection, there is a layer of cartilage on each bone, which protects the bones from overload and degeneration. Over the years, this cartilage layer is increasingly used up.
Among the factors that cause a much quicker rate of cartilage layer and a Schutzlosese rubbing against the bone ends include:

  • heavy loads,
  • inflammation
  • or previous injuries.

reason

Osteoarthritis of the ankle is most often caused by fractures of the upper ankle, which are healed in malposition. Hall sportsmen such as basketball or football players are particularly affected. These often compress or break the upper ankle during exercise and thus have a significantly increased risk of developing osteoarthritis over the years.
Even very loose ligaments and tendons can cause osteoarthritis. Due to the significantly lower stability, the ankle can no longer be properly held.
If the joint bones no longer fit together perfectly, the increased friction gradually destroys the cartilage.
In addition to these traumatic causes, inflammation can also promote ankle osteoarthritis. For this reason, rheumatism is the second most common cause of osteoarthritis. The chronic inflammation of the articular mucosa and the entire ankle can lead to severe damage to the articular cartilage over time, thereby destroying the entire joint over time.
Read more under: Inflammation in the ankle
Similarly, overweight may favor ankle osteoarthritis over time. Due to the heavy weight, which weighs on the knee and ankle in addition to the intervertebral discs, the joints can no longer withstand the weight after a long time. The articular cartilage is destroyed, destroying the joint. In some cases, however, no cause can be found. It is believed that a genetic component is also involved in the development of osteoarthritis, so that some patients tend to develop degeneration, although there are no predisposing factors.

clinic

Osteoarthritis usually causes severe pain, causing a painful restriction of movement that hinders the unrolling of the foot. In addition, cracking or rubbing noise may occur at an advanced stage. Due to the formation of small bony prominences in the joint, these can prevent a fluid passage. Affected patients describe a feeling of blockage in the ankle and ankle pain.
At the beginning of osteoarthritis, the symptoms only occur during heavy exercise, for example, during sports or long walks. The more cartilage is broken down in the joint, the more often and longer the pains in the movement occur. In some cases, patients also describe onset pain. This means that the first steps after a long break are particularly difficult.
Often there is an accompanying malalignment and swelling of the ankle due to the pain.
If osteoarthritis progresses, resting pain or fatigue pains appear.
The typical pain of osteoarthritis can be summed up easily:

  • Pain onset, which means more discomfort at the beginning of a movement,
  • load pain
  • and pain when climbing stairs, when running on unpaved roads or during sports.

diagnostics

Even in the anamnesis valuable information can be collected.

  • So are pain character,
  • Pain intensity and
  • Time of pain is often a good indication.

In addition, previous ankle injuries or inflammatory joint disease may indicate ankle osteoarthritis. For accurate diagnosis, imaging procedures are used:

  • Especially X-ray images in two levels under load allow a good assessment of the joint. Often a narrower joint space can be seen here. This indicates the attrition of the articular cartilage and thus an existing arthritis. Deformities of the joint or bony outgrowth as a sign of degeneration, which can hinder the joint, are a clear indication of ankle arthrosis.
  • To assess articular cartilage and possible damage to tendons or ligaments, an MRI of the foot is necessary. Above all, this procedure serves to accurately assess the damage, but not just the diagnosis.

therapy

In order to be able to take the correct measures with an existing ankle osteoarthritis, the disease should first be diagnosed.
If typical symptoms of ankle osteoarthritis occur, it is advisable to consult a doctor, who can diagnose the joint disease and expand treatment options after a comprehensive diagnosis. Here it is advisable to visit next to the attending family doctor and a specialist in orthopedics, as doctors of this specialty represent the specialists in the field of diagnosis and therapy of the ankle arthrosis.

If ankle osteoarthritis is diagnosed, usually conservative treatments are available at the beginning of therapy.
These include, in particular, physiotherapy and the wearing of special ankle bandages or insoles. Disease progression can often be prevented or at least slowed by using these therapies.
It is important to regularly carry out the exercises recommended by the doctor or physiotherapist in order to ensure the effectiveness of these measures. It should also be noted that an existing ankle osteoarthritis does not entail a ban on sport. Thus, lack of exercise can even promote the progression of the disease. It is more important to carry out the correct form of the movement and thus to improve the course of the disease. Also, the occurring symptoms can be treated therapeutically, which is why complaints that arise in ankle osteoarthritis should never go untreated. Another way to treat osteoarthritis is by injecting hyaluronic acid into the joint space.
Whether a Hyaluronsäuretherapie offers individually can best assess the attending physician.

If conservative measures do not succeed, the doctor may be approached on the possibility of carrying out operative measures. Depending on the cause of the occurrence of osteoarthritis, different methods can be used. In addition to stimulating the cartilage, a transplantation of cartilage tissue can be carried out, which can alleviate the symptoms and prevent progression of the disease.

The therapy at a glance

  • Conservatively, the ankle arthrosis can be treated with special shoe inserts. These consist in a sole roll or an arthrodesis boot, which achieve a pain relief and a functional improvement.
    Above all, the sole roll supports the rolling motion during running, which is often limited in the early stages of osteoarthritis. The arthrodesis boot stabilizes the ankle and supports it from the outside. Both orthopedic aids can significantly reduce the pain in the initial stage and improve mobility.
  • In some cases, anterior bone formations ( osteophytes ) can be milled off. If they are not removed, they can gradually damage the cartilage by rubbing the articular surfaces and destroy the joint space. The ablation improves mobility and relieves the pain. Furthermore, the progression of osteoarthritis can be significantly slowed down.
  • If the articular cartilage is already very degenerate, it can be newly bred in the laboratory and reinserted into the patient's remaining cartilage. The cartilage then grows back into the bone and stimulates the surrounding cartilage tissue for proliferation (growth).
    Alternatively, it is also possible to use membranes which are intended to promote the ingrowth of new cartilage cells.
    However, these methods are only suitable if a part of the cartilage is still preserved.
  • In case of severe osteoarthritis with complete loss of cartilage, the upper ankle can be replaced by an artificial joint. Thus, the mobility of the ankle can be maintained. If the artificial joint loosens after a few years, a new joint can be used.
    If this is not possible, or if there was no other option before, the ankle can be stiffened. Here, the destroyed cartilage is completely removed and then the ankle bone firmly screwed to the tibia. After about 6 to 12 weeks, the bones have grown stably together and the foot can again be loaded with almost no restrictions. Due to the great mobility in the lower ankle and the metatarsals, the stiffening can be partially compensated and thus leads to a loss of pain without restricting mobility too much.
    However, there is the possibility that the stiffening leads to an additional load on the other joints (knee joint, hip joint, spine). These are significantly more heavily burdened by the loss of mobility in the upper ankle and then may also show degenerative changes after a few years. Nevertheless, the stiffening is a very good and the quality of life significantly increasing alternative, if the other therapeutic methods are not possible or bring no success.

Sport in osteoarthritis of the ankle

Osteoarthritis of the ankle, unlike most other articular arthroses in the body, is a condition that often affects young people. Sports injuries represent the most common reason for the development of ankle arthrosis. In this case, ankle fractures are considered to be known triggers of the disease.

If there is a tendency to develop ankle arthrosis, improper exercise and obesity may increase joint wear.

Whether physical activity can be recommended for an existing ankle osteoarthritis depends on the individual degree of progression of the disease and the type of sport practiced. A general ban on sports can not be pronounced, as the movement of the stiffening of the joint and the wear of the cartilage are accelerated if there is no movement. However, sports that produce a high load on the ankle are also not recommended. Thus, particularly less stressful sports as well as special exercises and rehabilitation courses are recommended to influence the progression of the illness favorably. Therefore individual consultation with the treating orthopedist is advisable.

course

Ankle osteoarthritis generally takes a chronic course.
Thus, the wear of the joint progresses with time and as a result of the stress and causes more and more complaints as the disease progresses. A distinction must be made between primary and secondary ankle osteoarthritis.

  • The primary arthrosis is based on increased wear of the joint structures and typically occurs in middle to older age.
  • The secondary form of ankle osteoarthritis is much more common and is due to joint injury. Typical is a sports injury at a young age.

Depending on the present form of ankle osteoarthritis this may take a different course. For example, in a primary ankle osteoarthritis, the symptoms gradually creep in and slowly get worse over time. The complaints of a secondary ankle osteoarthritis can usually be related to an injury to the ankle and the symptoms develop significantly faster in comparison.
Therapy should always be made for a diagnosed ankle osteoarthritis. Osteoarthritis of the ankle is very difficult to treat and in many cases progresses slowly despite therapeutic measures.

Summary

The arthrosis of the ankle is a very common problem due to the heavy load. In most cases, previous injury or rheumatic disease is the cause of osteoarthritis. But also constant overloads by massive overweight or heavy loads can cause ankle arthrosis.
Osteoarthritis is clinically manifested by severe pain, initially on exertion, at an advanced stage even at rest. In addition, the mobility can be significantly limited.
Anamnesis and radiographic procedures can be used to make the diagnosis. In particular, joint space narrowing and new bone formation in the joint space are clearly visible and a clear sign of ankle arthrosis.
In the initial stage, the discomfort of orthopedic shoe inserts can be improved. In later stages, operative measures are often necessary. The operation offers several options in the case of ankle arthrosis:

  • Thus, the cartilage can be rebuilt by implantation of cartilage cells,
  • New bone formations are removed
  • or a complete joint replacement made.
  • The last option is to stiffen the joint, which is a good therapeutic method and provides satisfactory results, especially in terms of pain relief.
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