In the human foot, there are 26 bones, there are 3 sections - the metatarsus, tarsus and calcaneus. The talus is located in the tarsus, to which the tibia of the lower leg and tibia are connected, and 3 bones of the middle tarsal division are scaphoid, cuboid, and calcaneus. The talus is a kind of meniscus between the foot and lower leg. Its joints are very important for the biomechanics of the foot as a whole, they evenly distribute the load between the front and rear parts of the foot.
The ram-calcaneo-navicular (it is often called the ram-navicular) joint and the subtalar are the most mobile joints of the foot, they are responsible for the rotation and abduction of the foot. The ram-calcaneal joint has a spherical shape and connects to the subtalar joint. Strength is ensured by a wide ram-calcaneal ligament.
Note. The ram-navicular joint (TLS) has the greatest load. The talus creates lateral stability, but the main stress is on the inside of the foot. With uneven load on the foot, it is deformed, and arthrosis of the talar-navicular joint of the foot develops.
Causes of joint arthrosis
The main function of the foot is to maintain the vertical position of the body, and the width of the foot is determined by its growth. The mismatch of these relationships also causes TLS arthrosis. Pathology often develops after 20 years. And after 55 years, 80% of people experience arthrosis and osteoarthrosis of the scaphoid-scaphoid joint.
Arthrosis of this joint is in 2nd place among the pathologies of the foot.
Each person during his life received an ankle injury, but if it becomes systematic, then arthrosis develops in the scaphoid-navicular joint.
Often, after receiving an education and getting a job, a person becomes a hostage of inactivity and gains weight. These are provoking factors of arthrosis.
Any inflammatory pathology of the extremities can be attributed to provocative factors: arthritis, chronic tendonitis, polyarthritis. In addition to diseases, close, narrow model shoes, high heels, overweight, working with prolonged stays on legs, and frequent hypothermia can affect the development of pathology.
The risk group includes ballerinas, athletes and dancers. With age, the tissues age, the articular surfaces wear out, metabolism is disturbed, and a bunch of other diseases is recruited.
Flatfoot, degenerative changes in cartilage and tendons (congenital and acquired), and autoimmune pathologies also have a bad effect on the joints, leading to arthrosis of the talacaneco-navicular joint.
With a genetic predisposition, collagen synthesis and cartilage defects may be impaired. An important role can be played by malnutrition with a deficiency of vitamins and minerals.
Classification
Depending on the severity of the deformity, 3 degrees of severity of arthrosis of TLS are distinguished. Arthrosis is congenital and acquired. The first option develops against a background of congenital defects in the joints and bones. The second is most often a complication after fractures or surgery (in this case, bone tissue fusion is disturbed).
Symptomatology
The main common signs of pathology are: swelling of the foot and ankles, inflammatory-pain syndrome, myalgia. Let's consider each stage separately.
1 degree of change
Arthrosis of the talar-navicular joint of the 1st degree is the primary stage of pathology in which pain is absent at rest. Slight soreness in the heel area is noted after prolonged physical exertion, as well as long distances traveled on foot.
The pain goes away after a short rest. These are the first signs of illness in the form of discomfort after long walks that cannot be ignored.
With arthrosis of the ram-navicular joint of the 1st degree, the cartilage begins to crack, thin, dries, but inside the joint bag. Depreciation ability and microcirculation are reduced, elasticity is reduced.
Such cartilage does not perform depreciation between the bones, there is a narrowing of the joint space. The legs quickly tire, periodically there is pain during exertion in the calcaneal region. Joint gap only at the beginning of its narrowing. Although the pain is mild, it is accompanied by inflammation.
Treatment of osteoarthrosis of the talar-navicular joints of the 1st degree is successful with an early visit to the doctor and does not give complications.
2 degree of deformation
With arthrosis of the talar-navicular joint of stage 2, the pain becomes of moderate intensity, and for its elimination it takes a long rest. The foot is externally swollen, and when pressed, pain appears. Arthrosis of the talar-navicular joint of the 2nd degree already proceeds with deformation of the foot and limitation of its mobility.
The third stage is the most dangerous - it is acute arthrosis. The pain becomes constant, cartilage tissue is destroyed almost completely, joint movements are almost impossible.
With arthrosis of the talar-navicular joint of the 2nd degree, bone density increases, and osteophytes begin to grow along the edges. The gap is narrowed noticeably. The foot is deformed and hurts a lot when moving.
A characteristic feature is the patient’s gait: his foot turns to the inside when walking. Walking hurts, there is constant crunching and swelling of the affected area.
Osteoarthrosis of the talar-navicular joint of the 2nd degree has an already more pronounced, but tolerable pain syndrome.
3 degree of deformation
The third stage is the most dangerous. The pain becomes constant, it radiates to the knee and spills over all the feet. Cartilage tissue is destroyed almost completely, joint movements are impossible.
At stage 3, the joint gap is practically absent, the spurs are enlarged so that they are visible through the skin. The foot is deformed, under the thumb the corns becomes old and dense. The finger itself is immobilized.
The consequences of arthrosis TLS
In advanced cases, other foot joints are involved in inflammation, depreciation weakens, and the load on large joints of the legs increases.
Muscles weaken and atrophy. They can be injured by osteophytes. The foot is deformed so much that it is difficult to pick up shoes, constant pain causes lameness. Therefore, arthrosis of TLS even of the 1st and 2nd degrees becomes the basis for unfitness for military service.
Diagnostic Methods
Of the visual signs, gait changes can be noted - the patient spares the back of the foot when walking due to pain.
On radiography, you can see all stages of changes in arthrosis.
Arthroscopy helps to examine the condition of cartilage and tendons. This operation without incisions is performed when other research methods have not yielded accurate results.
CT gives layered images of joint tissues. MRI is used to detect any joint pathologies.
Treatment
The treatment of osteoarthritis of the osteoarthritis is based on complex therapy combining conservative and surgical treatment. Conservative consists of drug and alternative treatment.
Drug therapy
Treatment depends on the stage of arthrosis and the reasons. It consists in taking non-steroidal drugs. They are prescribed for 2 weeks.
In the subacute stage and in remission, NSAIDs are not used. The use of hormonal drugs is strictly according to the indications. Analgesics are prescribed to reduce pain.
At stages 1-2, the use of chondroprotectors is recommended. Many studies have not fully proven the effect of these agents.
To improve blood flow, drugs that improve microcirculation, angioprotectors are indicated. With muscle cramps, muscle relaxants are prescribed. Auxiliary use ointments, gels with irritating, warming, anti-inflammatory effect.
Injection therapy
Treatment with the introduction of drugs into the dystrophic zone is effective for arthrosis of the 1st and 2nd degree. To remove inflammation in severe cases, the use of GCS (glucocorticoids) and hyaluronic acid inside the joint or in periarticular tissues is used.
Hyaluronic acid is similar in composition to articular fluid, which acts as a lubricant and absorbs stress on the joint, distributing them evenly. With dystrophic processes, its volume decreases, pain appears due to friction of the articular surfaces with each other.
Helps in the treatment of arthrosis and wearing specialized orthopedic appliances that help temporarily fix the joint and unloading it.
Proper nutrition is one of the components of a comprehensive adequate treatment for arthrosis. Why is it important? Because proper nutrition will help normalize weight and reduce the load on the joints, while metabolism is normalized due to a decrease in the level of harmful foods and an increase in wholesome ones.
From products you need to choose those that contain collagen, sulfur and selenium. These are the building blocks for cartilage:
- jelly, jelly, aspic;
- linseed oil and nuts;
- onions, garlic, seafood, chicken, veal;
- cereals without enhanced heat treatment.
Surgery
Arthrodesis of TLS is performed when conservative treatment is ineffective, when persistent pain persists and signs of disability are observed or loss of support function occurs.
Arthrodesis is an artificial analogue of joint ankylosis. During the operation, under general anesthesia, the damaged cartilage is completely removed and the surfaces of the articulating bones are tightly fixed.
After the coalescence of friction and pain will be gone. In the X-ray image, they will give one solid line.
To accelerate the fusion, squeeze the ends of the joint with a special apparatus.
Operation time from 2 and more hours. An operation will be considered successful only if:
- limbs in length remained the same;
- there is no pain when walking no less than 4 km;
- it is possible to wear ordinary shoes.
Non-drug therapy
The most important components of treatment are exercise therapy and gymnastics. They should be performed for life. Breaks are permissible only during exacerbations.
What do they give:
- reduce the load on the sore joint;
- strengthen muscles, increase ligament strength;
- will prevent the development of contractures.
It is very useful to massage the feet after gymnastics yourself. Swimming is also shown.
Physiotherapy
These methods are used only in remission and without exacerbations. They help relieve pain and inflammation.
Apply:
- UHF;
- laser and magnetotherapy;
- electrophoresis;
- paraffin and mud therapy;
- healing baths.
Conduct procedures courses.
From alternative medicine used: hirudo-, phyto- and apitherapy, acupuncture.
Prevention
Regular, but moderate exercise is the first condition for prevention. Only the work of the joint itself will protect it from further deformation, strengthen and create a muscle corset, and improve blood circulation in the affected area. If even minor manifestations of osteoarthritis of arthrosis appear, it is necessary to consult a doctor for examination.
It is necessary to exclude the possibility of injuries and hypothermia, balance nutrition without abuse of fatty meat products, normalize weight, wear comfortable shoes. The planning of the day should be such that the legs rest several times a day. Inflammatory foot diseases should be treated promptly.