Introduction / definition
The 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 Overloads occurs. Due to the heavy load on the upper ankle, osteoarthritis is one very common Disease, which however conservative at the beginning very well treated can be.
ICD / GdB
In the ICD classification it is the so-called "international statistical classification of diseases and related health problems". It serves to classify health impairments in the health system and is used in Germany, among other places. Each disease is assigned its own combination of numbers and numbers in the ICD classification. The ankle joint arthrosis can be found under the umbrella term “other arthrosis” and is specifically included M19.07 figured.
GdB stands for "degree of disability" and describes the classification of the impairment that can be caused by different diseases. The graduation takes place on a table up to 100 in steps of 10. Depending on the extent of the impairment, a different number of points are assigned. A value of 50 and above is a severe disability. Ankle arthrosis can cause a GdB of 0 to 40, depending on the extent of the disease and the individual impairment. The GdB is determined by a medical expert.
Structure / pathogenesis
The ankle joint consists of three communicating joint surfaces:
- The end of the Fibula (Fibula),
- end of Shin (Tibia)
- and the talus.
So that these bone ends do not rub against each other without protection, is on each bone a Cartilage layerwhich protects the bones from overload and degeneration. Over the years, this layer of cartilage increasingly wears out.
The factors that cause the cartilage layer to undergo much faster damage and the bone ends rubbing against each other are:
- heavy loads,
- or previous injuries.
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Athletes (joggers, soccer players, etc.) are particularly often affected by diseases of the foot. In some cases, the cause of the foot discomfort cannot be identified at first.
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Arthrosis of the ankle occurs on most common after healed fractures of the upper ankle joint. Indoor athletes such as Basketball or soccer player. These compress or break the ankle joint, particularly often during sport, and thus have a significantly increased risk of developing osteoarthritis over the years.
Also special loose ligaments and tendons can cause osteoarthritis.Due to the significantly lower stability, the ankle can no longer be held properly.
If the joint bones then no longer fit perfectly on top of one another, go through the increased friction, the cartilage gradually lost.
Besides these traumatic causes you can also Inflammation favor ankle osteoarthritis. This is why Rheumatism the second most common cause for osteoarthritis. The chronic inflammation of the synovial membrane and the entire ankle can lead to severe damage to the articular cartilage over time and thereby destroy the entire joint over time.
Read more about this at: Inflammation in the ankle
Likewise can very overweight favor ankle arthrosis over time. Due to the heavy weight, which is mainly on the intervertebral discs Knee- and Ankle joint the joints can no longer withstand the weight after a long time. The articular cartilage perishes and thus destroys the joint. In some cases but it is never mind to find. It is believed that one too genetic component is involved in the development of osteoarthritis, so some patients are prone to develop degeneration even though there are no predisposing factors.
The osteoarthritis usually leads to severe pain and thereby causes a painful Restriction of movementwhich prevents the foot from rolling. In addition, at an advanced stage Clicking or rubbing noises occur. Due to an education smaller Bony prominences in the joint, these can prevent a smooth gait. Affected patients describe a feeling of blockage in the ankle and Ankle pain.
At the start the symptoms only add to the osteoarthritis great burden, for example during sports or long walks. The more cartilage is broken down in the joint, the more frequently and for longer the pain occurs during movement. In some cases describe the patients too Starting pain. This means that the first steps after a long break are particularly difficult.
Often times because of the pain there is accompanying deformity and swelling of the ankle.
If the osteoarthritis progresses, also kick Resting pain or Fatigue pain on.
The typical pains of osteoarthritis can be easily summarized:
- Start-up pain, which means stronger discomfort at the beginning of a movement,
- Exercise pain
- and pain when climbing stairs, walking on unpaved roads or during exercise.
Already in the anamnese valuable information can be collected.
- So are Pain character,
- Pain intensity and
- Timing of pain often a good indication.
In addition, previous injuries to the ankle or inflammatory joint diseases can indicate ankle osteoarthritis. Imaging procedures are used for precise diagnosis:
- Especially X-rays in two planes under load allow a good assessment of the joint. Often you can get involved here narrowed joint space detect. This indicates the abrasion of the articular cartilage and thus an already existing arthrosis. Also Misalignments of the joint or bony outgrowths as signs of degeneration that can hinder the joint are a clear indication ankle osteoarthritis.
- To assess the articular cartilage and possible damage to tendons or ligaments is one MRI of the foot necessary. This procedure is primarily used for the precise assessment of the damage, but not only for diagnosis.
In order to be able to take the correct measures in the event of an ankle arthrosis, the disease should first be diagnosed.
If typical symptoms of ankle joint osteoarthritis occur, it is advisable to consult a doctor who, after a comprehensive diagnosis, can diagnose the joint disease and develop therapy options. In addition to the treating family doctor, there is also a Specialist in Orthopaedics because doctors in this field are specialists in the diagnosis and treatment of ankle arthrosis.
If the ankle joint arthrosis is diagnosed, they usually stand conservative methods of treatment at the beginning of therapy.
This particularly includes physiotherapy and wearing special ones Ankle bandages or deposits. These therapies can often prevent the disease from progressing or at least slow it down.
It is important to regularly perform the exercises recommended by the doctor or physiotherapist to ensure the effectiveness of these measures. It should also be noted that there is an osteoarthritis of the ankle no sports ban entails. A lack of exercise can even promote the progression of the disease. It is more important to carry out the correct form of movement and thus to improve the course of the disease. The symptoms that occur can also be addressed therapeutically, which is why complaints that arise from ankle arthrosis should never be left untreated. Another way to treat osteoarthritis is by injecting Hyaluronic acid into the joint space.
The attending physician can best assess whether hyaluronic acid therapy is an individual option.
If conservative measures are unsuccessful, the doctor can be asked about the possibility of performing surgical measures. Different procedures can be used depending on the cause of the osteoarthritis. In addition to stimulating the cartilage, a Cartilage tissue transplant which can alleviate the symptoms and prevent the disease from progressing.
The therapy at a glance
- Ankle arthrosis can be conserved special shoe insoles therapy. These consist of one Sole roll or one Arthrodesis bootswhich one Pain relief and a Function improvement achieve.
The Sole roller supported especially the Rolling movement while running, which is often restricted in the early stages of osteoarthritis. Through the Arthrodesis boots will that Ankle joint stabilized and supported from the outside. Both orthopedic technical aids can significantly alleviate pain in the initial stage and improve mobility.
- In some cases it can be anterior New bone formation (Osteophytes) milled off become. If they are not removed, the rubbing of the joint surfaces can gradually damage the cartilage and destroy the joint space. The ablation improves mobility and also alleviates pain. Furthermore, the progression of the osteoarthritis can be clearly seen slowed down become.
- Is the Articular cartilage already very degenerated, this can newly grown in the laboratory and the patient again inserted into the remaining cartilage become. The cartilage then grows back into the bone and stimulates the surrounding cartilage tissue to proliferate (growth).
Alternatively you can also Membranes can be used, which should encourage the ingrowth of new cartilage cells.
This However, processes are only suitableif another Part of the cartilage preserved is.
- In the case of very pronounced osteoarthritis with complete loss of cartilage surface can the upper ankle through a artificial joint be replaced. In this way, the mobility of the ankle can be maintained. If the artificial joint loosens after a few years, a new joint can be inserted.
If this is not possible, or if there was no other option before, the ankle can stiffened become. The destroyed cartilage is completely removed and the ankle bone is then screwed tightly to the shin bone. After approx. 6 to 12 weeks the bones have grown stably together and the foot can be loaded again with almost no restrictions. Through the great mobility in the lower ankle and metatarsal bones the stiffening can be partially compensated and thus leads to a Loss of pain without restricting mobility too much.
However, there is a possibility that the stiffener becomes a More stress on the other joints (Knee joint, hip joint, Spine) leads. The loss of mobility in the ankle joint puts a much greater strain on them and can also show degenerative changes after a few years. Still, the stiffener is a very good one and that Alternative that significantly increases quality of lifewhen the other therapeutic methods are not possible or do not work.
Exercise for osteoarthritis of the ankle
The Arthrosis of the ankle In contrast to most other osteoarthritis of the joint in the body, it is a disease that often affects young people. Sports injuries are the most common Reason for emergence Ankle joint arthrosis. Here, ankle joint fractures are known to be the cause of the disease.
If there is a tendency to develop ankle osteoarthritis, incorrect exercise and excess weight can increase wear and tear on the joint.
Whether or not physical activity can be recommended in the presence of ankle osteoarthritis depends on the individual degree of progression of the disease and the type of sport practiced. A general sports ban cannot be pronounced, as lack of movement accelerates the progression of the stiffening of the joint and the wear and tear of the cartilage. Sports that put a lot of stress on the ankle are also not recommended. Less stressful sports as well as special exercises and rehabilitation courses are particularly recommended in order to have a positive influence on the progression of the disease. Individual consultation with the orthopedic surgeon is therefore advisable.
Ankle arthrosis generally takes a chronic course.
The wear and tear of the joint progresses over time and as a result of stress and causes more and more complaints as the disease progresses. It must be between one primary and one secondary ankle arthrosis can be distinguished.
- The primary osteoarthritis is based on increased wear and tear of the joint structures and typically occurs in middle to older age.
- The secondary form Ankle arthrosis is far more common and occurs due to an injury to the joint. A sports injury at a young age is typical.
Depending on the type of ankle arthrosis, it can take a different course. In the case of primary ankle joint arthrosis, the symptoms occur gradually and only slowly get worse over time. The symptoms of secondary ankle osteoarthritis can usually be associated with an injury to the ankle and the symptoms develop significantly faster in comparison.
Therapy should always be undertaken if ankle osteoarthritis is diagnosed. Ankle arthrosis is very difficult to treat and in many cases progresses slowly despite therapeutic measures.
Osteoarthritis of the ankle is a very serious problem due to the heavy strain common problem. In most cases they are previous injuries or one rheumatic disease Cause of osteoarthritis. But also permanent Overloads Being overweight or exerting a lot of pressure can cause ankle arthrosis.
The osteoarthritis makes itself clinically strong Pain, initially under load, in advanced stage also at rest noticeable. In addition, the Mobility clearly restricted be.
Through the anamnese and radiological procedure the diagnosis can be made. Especially one 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 let the complaints through orthopedic shoe insoles improve. In later stages are often operational measures necessary. In the case of ankle arthrosis, the operation offers various options:
- So the cartilage can get through Implantation of cartilage cells to be rebuilt,
- New bone formation become worn away
- or a complete joint replacement performed.
- The last option is the Stiffening of the jointwhich is a good therapeutic method and gives satisfactory results, especially with regard to pain relief.