Will this painful ankle ever go away? (pt2)
Osteoarthritis is the most common type of arthritis. It is also known as degenerative arthritis or wear-and-tear arthritis.
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Unlike the ankle sprain discussed last week, osteoarthritis is a disease of ageing. In addition, obesity, joint injury and joint malformation are all contributory factors to development of osteoarthritis.
Breakdown of the cartilage, the protective tissue that covers the joints can lead to osteoarthritis.
This protective tissue is damaged by age and repeated motion resulting in increased friction as the bones of the joint rub against each other.
The most common symptoms of Osteoarthritis are pain and stiffness. It can occur in any joint including the ankle joint.
Osteoarthritis is a slow-developing disease, usually remains silent until it begins to cause painful or debilitating symptoms.
In advanced stages, there is swelling, pain and limitation of daily activities such as:
- Getting in and out of chairs
- Bathing
- Dressing
- Putting on shoes
Treatment varies from individual to individual. Many people can get symptom relief with analgesics. Other treatment options that can relieve the symptoms include weight reduction options and physiotherapy.
In some extreme cases, surgical management to repair or replace a joint tissue is indicated.
Another cause of painful, swollen ankle is tenosynovitis. This results from an inflammation of the sheath or covering of the tendons.
A tendon is a type of fibrous tissue that connects the muscles to the bones, making possible such actions as running, jumping and lifting.
Tendons are covered by a protective sheath known as a synovium. This sheath produces a fluid that keeps the tendon lubricated.
Injury to this area of the body may impair the function of the synovium. If this occurs, the sheath may fail to make the fluid or may not make enough fluid. This can cause inflammation or swelling of the synovium.
Tenosynovitis is typically caused by injury to the tendon or surrounding muscle or bone. Certain jobs appear to have greater risk, such as carpentry, dentistry and office work because of repetitive and prolonged motions, injury and strains involved in these works.
It may also result from systemic conditions such as gout and diabetes.
Certain tendons in the body are more susceptible to injury, primarily those in the hands, feet, and wrists explaining why tenosynovitis is more common in these areas.
However, it can occur in any tendon in the body, including the shoulder, elbow and knee.
Symptoms include joint stiffness, swelling, pain and tenderness, discolouration of the skin overlying the joint and in some cases fever if an infectious agent is involved.
Diagnosis is usually through physical examination of the affected areas but other differentials would have to be excluded by means of MRI of the affected joint.
Treatment options is aimed at reducing inflammation and pain. This can be done by resting the affected area and stopping activities that caused the initial injury. A brace or splint to immobilise the affected area may be recommended.
Heat or cold compresses may also help reduce swelling and pain, so are antiinflammatory medications.
Corticosteroids can also be injected into the inflamed area to minimise the inflammation and pain.
Antibiotics may be given if infection is the cause or a complication of the condition.
Once the tendon has healed, exercises or physical therapy to strengthen the muscles may be recommended.
Strengthening the muscle will help protect the tendon from injury in the future. Recurrent tenosynovitis may require surgery to correct the underlying problem.
Tenosynovitis can be prevented by avoiding movements or motions that are repetitive or forceful. Strengthening of the muscles around the joint can also help prevent this type of injury. Stretching and range of motion exercises are also beneficial.
From the conditions discussed, physiotherapy is an integral part of management of ankle joint swellings and pain.
Depending on the cause, physiotherapy at different stages of treatment for the various causes of ankle swellings is recommended.
