Ayaq biləyi ağrısı

Ayaq biləyi adətən tək oynaq adlandırılsa da, əslində iki oynaqdır:

Əsl topuq oynağı üç sümükdən ibarətdir :

  • tibia, ayaq biləyinin daxili hissəsini təşkil edən iki aşağı ayaq sümüyündən daha böyük və daha güclüdür.

  • fibula, ayaq biləyinin xarici hissəsini təşkil edən alt ayağın kiçik sümüyü

  • the talus, a small bone between the tibia and fibula and the calcaneus, or heel bone.

The subtalar joint, which is composed of two bones:

  • the talus
  • the calcaneus

The ends of the bones are covered by articular cartilage. The space in the joint is lined with a thin membrane called the synovium, which cushions the joint and secretes a lubricating fluid, called synovial fluid.

Several strong bands of connective tissue, called ligaments, hold the bones of the ankles together. They include the following:

  • anterior tibiofibular ligament, which connects the tibia to the fibula
  • lateral collateral ligaments, which connect the fibula to the calcaneus and provide stability to the outsides of the ankles
  • deltoid ligaments, which attach the tibia to the talus and calcaneus and provide stability to the insides of the ankles

A number of tendons run through the ankle, attaching muscles of the lower leg to the bones of the foot and ankle. The major tendons include the following:

  • Achilles tendon, which attaches the calf muscle and calcaneus
  • flexor hallicus longus, which runs along the inside of the ankle and attaches to the big toe
  • flexor digitorum, which runs along the inside of the ankle and attaches to the other toes
  • peroneal tendons, a set of three tendons which run along the outside of the ankle and attach at the 5th metatarsal (the shaft of the small toe) and the bottom of the foot
  • posterior tibialis tendon, which attaches at the mid-foot and helps maintain the foot's arch
  • anterior tibialis tendon, which runs down the front of the leg and attaches to the bones of the midfoot. These tendons pull the foot toward the body and help control their motion.

Many forms of arthritis and related conditions that affect the joints, muscles and/or bones can cause problems like pain, stiffness and swelling in the ankles. Here are some diseases that can affect the ankles.

  • Osteoarthritis (OA). The most common form of arthritis, osteoarthritis is a chronic condition characterized by the breakdown of the cartilage that cushions the ends of the bones where they meet to form joints. This breakdown causes the bones to rub against each other, causing stiffness, pain and loss of movement in the joint. In the foot, the most commonly affected joint is the big toe, but OA can also affect the ankle.
  • Rheumatoid arthritis (RA). Rheumatoid arthritis is a chronic inflammatory disease of the joints that occurs when the body’s immune system – which normally protects us from infection – mistakenly attacks the synovium, the thin membrane that lines the joints. The result can be joint damage, pain, swelling, inflammation, loss of function and disability. In about 90 percent of people with rheumatoid arthritis, the joints of the feet are ankles are affected.
  • Juvenile arthritis. Juvenile arthritis is the term used to describe arthritis when it begins before age 16. There are several different types of juvenile arthritis that can cause pain and swelling in the ankles.
  • Gout. Gout is a form of  arthritis that occurs when excess uric acid, a bodily waste product circulating in the bloodstream, is deposited as needle-shaped monosodium urate crystals in tissues of the body, including the joints. For many people, the first symptom of gout is excruciating pain and swelling in the big toe – often following a trauma, such as an illness or injury. Subsequent attacks may occur off and on in other joints, including the ankles. After years with the disease, lumps of uric acid, called tophi, may form beneath the skin around the ankles.
  • Calcium Pyrophosphate Dihydrate Crystal Deposition Disease (Pseudogout). Like gout, pseudogout occurs when crystals form within the joints. With pseudogout, however, the crystals are formed of a salt called calcium pyrophosphate dihydrate. Although pseudogout occurs mostly in older people, it can affect younger people, particularly if they have other health problems. Also like gout, pseudogout can cause intense pain and swelling, which often comes up overnight. Pseudogout most commonly affects the knees, but it can also affect other joints, including the ankles.  
  • Reactive arthritis. Reactive arthritis is a chronic form of arthritis that often occurs following an infection of the genital, urinary or gastrointestinal system. Features of reactive arthritis include inflammation and swelling of the joints, eyes and structures within the gastrointestinal or genitourinary tracts, such as intestines, kidneys or bladder. The ankles, knees and joints of the feet often are the first joints affected by reactive arthritis. Reactive arthritis also can cause inflammation of the tendons, including the Achilles tendon at the back of the ankle.
  • Lupus. Lupus is a chronic autoimmune disease, meaning the body's immune system creates antibodies that attack healthy tissues, including the joints, skin, heart, lungs and kidney. In some people with lupus, arthritis affects the ankles. However, swelling of the ankles may be a sign of kidney involvement.
  • Psoriatic arthritis. Psoriatic arthritis is a form of arthritis accompanied by the skin disease psoriasis. The skin disease often precedes the arthritis; in a small percentage of cases the joint disease develops before the skin disease. Psoriatic arthritis commonly involves the ankle.
  • Infectious arthritis. Also called septic arthritis, infectious arthritis refers to arthritis that is caused by an infection within the joint. Infectious arthritis is often caused by bacteria that spread through the bloodstream to the joint. Sometimes it is caused by viruses or fungi and can affect the ankles. Untreated, infection can lead to joint destruction.
  • Scleroderma. Literally translated "hard skin," scleroderma is an umbrella term for disorders that involve the abnormal growth of the connective tissue supporting the skin and internal organs. In some cases skin thickening over the joints, such as the ankle, can cause joint stiffness.

Although many forms of arthritis and related conditions can affect the ankles, the most common cause of ankle pain is a sprain. A sprain occurs when the ligaments that support the ankle become stretched or torn. Here is what you need to know about sprained ankles and some other common ankle injuries.

  • Sprains. The most common ankle injury, sprains occur when the ligaments that normally support the ankle become stretched beyond their normal range. This happens when the foot twists, turns or rolls as a result of fall or misstep. Doctors grade sprains on a scale of one to three, based on the severity of the damage, with one representing slight stretching and some damage to the ligament fibers and three representing a complete tear of the ligament.
  • Ankle fractures. A fractured, or broken, ankle may include a break in one of the bones that make up the ankle, or it could consist of several breaks in different bones. An ankle fracture can occur if you twist or roll your ankle while walking, running, going up or down stairs or while playing sports, such as sliding into base during baseball. It can also result from tripping or falling or the impact of a car accident. A broken ankle can cause the same symptoms as a sprained ankle – severe pain, swelling, bruising, tenderness to the touch, or deformed appearance – so it can be hard to distinguish between the two.

In some cases a fracture occurs because a ligament tears and pulls a piece of bone with it. This is called an avulsion fracture.

If you have an ankle injury, it's important to see a doctor who can X-ray the ankle to see if it is broken or sprained.

Learn more about ankle fractures from the American Academy of Orthopaedic Surgeons.

  • Achilles tendinitis. Achilles tendonitis is inflammation of the Achilles tendon, the largest tendon in the body, which runs from the calf to the heel bone.
    • Noninsertional Achilles tendonitis affects fibers in the middle of the tendon.
    • Insertional Achilles tendonitis affects the lower portion of the tendon where it attaches to the heel bone.

Both types can result from repetitive stress to the tendon or from overstressing the tendon during exercise. Damaged tendon fibers can calcify and bone spurs can form where the tendon attaches to the bone.

Symptoms may include pain and stiffness of the tendon – which may occur from either inactivity (such as first thing in the morning) or after activity – thickening or swelling of the tendon or bone spurs.

Learn more about Achilles Tendonitis from the American Academy of Orthopaedic Surgeons.

  • Achilles tendon rupture. An Achilles tendon rupture is a break in the Achilles tendon. Most ruptures occur during strenuous activity. The break itself may cause a loud pop and feel like the ligament has been kicked or shot. Symptoms of a ruptured tendon may include severe pain and swelling, difficulty walking and the inability to stand on the toes of the injured foot.

Although many forms of arthritis and related conditions can affect the ankles, the most common cause of ankle pain is a sprain. A sprain occurs when the ligaments that support the ankle become stretched or torn. Here is what you need to know about sprained ankles and some other common ankle injuries.

  • Sprains. The most common ankle injury, sprains occur when the ligaments that normally support the ankle become stretched beyond their normal range. This happens when the foot twists, turns or rolls as a result of fall or misstep. Doctors grade sprains on a scale of one to three, based on the severity of the damage, with one representing slight stretching and some damage to the ligament fibers and three representing a complete tear of the ligament.
  • Ankle fractures. A fractured, or broken, ankle may include a break in one of the bones that make up the ankle, or it could consist of several breaks in different bones. An ankle fracture can occur if you twist or roll your ankle while walking, running, going up or down stairs or while playing sports, such as sliding into base during baseball. It can also result from tripping or falling or the impact of a car accident. A broken ankle can cause the same symptoms as a sprained ankle – severe pain, swelling, bruising, tenderness to the touch, or deformed appearance – so it can be hard to distinguish between the two.

In some cases a fracture occurs because a ligament tears and pulls a piece of bone with it. This is called an avulsion fracture.

If you have an ankle injury, it's important to see a doctor who can X-ray the ankle to see if it is broken or sprained.

Learn more about ankle fractures from the American Academy of Orthopaedic Surgeons.

  • Achilles tendinitis. Achilles tendonitis is inflammation of the Achilles tendon, the largest tendon in the body, which runs from the calf to the heel bone.
    • Noninsertional Achilles tendonitis affects fibers in the middle of the tendon.
    • Insertional Achilles tendonitis affects the lower portion of the tendon where it attaches to the heel bone.

Both types can result from repetitive stress to the tendon or from overstressing the tendon during exercise. Damaged tendon fibers can calcify and bone spurs can form where the tendon attaches to the bone.

Symptoms may include pain and stiffness of the tendon – which may occur from either inactivity (such as first thing in the morning) or after activity – thickening or swelling of the tendon or bone spurs.

Learn more about Achilles Tendonitis from the American Academy of Orthopaedic Surgeons.

  • Achilles tendon rupture. An Achilles tendon rupture is a break in the Achilles tendon. Most ruptures occur during strenuous activity. The break itself may cause a loud pop and feel like the ligament has been kicked or shot. Symptoms of a ruptured tendon may include severe pain and swelling, difficulty walking and the inability to stand on the toes of the injured foot.

Often a sample of blood or joint fluid can help you doctor confirm a diagnosis. For example, a blood test showing high blood levels of rheumatoid factor – an antibody that acts against the blood component gamma globulin – or an antibody called anti-cyclic citrullinated peptide antibody (anti-CCP) may suggest rheumatoid arthritis. High levels of antinuclear antibodies (ANAs), abnormal antibodies directed against the cells' nuclei, could suggest lupus or another inflammatory disease. 

Tests of fluid drawn with a needle from the joint may reveal crystals of uric acid, confirming a diagnosis of gout; calcium pyrophosphate dehydrate, confirming pseudogout; or a bacterium, suggesting that joint inflammation is caused by an infection.

Diagnosing an ankle problem will begin with a physical exam and assessment of your medical history. During the medical history your doctor will ask you questions such as:

  • What symptoms are you experiencing?
  • When did you first start noticing them? Were they the result of an injury?
  • Are your symptoms worse after activity or rest? Are there certain activities that make them worse – or better?
  • Do you recall having an illness or accident around the time your symptoms began?
  • Are you experiencing symptoms in any joints besides the ankle(s)?
  • Do any of your family members have arthritis or other ankle problems?
  • Do you have other medical problems that could be causing your symptoms?

During the physical exam your doctor will look at and touch your ankles and any other joints you may be experiencing problems with. Your doctor will be looking for areas that have tenderness, pain or swelling, as well as indications that the joint may be damaged. Depending on the findings of the history and exam, your doctor may order lab tests and imaging tests to help make or confirm a diagnosis.

 

Medications to ease pain, relieve inflammation, slow bone loss, modify the course of an inflammatory disease or prevent joint damage are an important part of treatment for many ankle problems. The medications used to treat arthritis and other problems that affect the ankles will depend largely on the form of arthritis or related condition you have. The types of medications commonly used in arthritis treatment are:

Nonsteroidal anti-inflammatory drugs. Including more than a dozen different drugs, some of which are available without a prescription, nonsteroidal anti-inflammatory drugs (NSAIDs) are used to help ease arthritis pain and inflammation. They are used for all forms of arthritis.

Corticosteroids. These quick-acting drugs, similar to the cortisone made by your own body, are used to control inflammation. If inflammation is due to a systemic inflammatory disease, your doctor may prescribe oral corticosteroids. If inflammation is limited to one or a few joints, your doctor may inject a corticosteroid preparation directly into the joint.

Analgesics. Analgesics are among the most commonly prescribed drugs for many forms of arthritis. They also may be used to relieve pain from ankle sprains, fractures and other injuries. Unlike NSAIDs, which target both pain and inflammation, analgesics are designed purely for pain relief. For that reason, they may be safe for people who are unable to take NSAIDs due to allergies or stomach problems, for example. When used as prescribed, they’re also an appropriate, and possibly safer, choice for people whose arthritis causes pain but not inflammation.

If pain is in the soft tissues, you may find relief from an analgesic salve, rub or balm available over the counter under trade names such as Aspercreme, Ben-Gay, Capzasin-P, Eucalyptamint, Icy Hot, Voltaren Gel and Zostrix. These topical preparations work through a variety of active ingredients and may be helpful if you are unable to take oral medications, or if medications fail to relieve pain or reduce it to a manageable level.

Disease modifying anti-rheumatic drugs. Disease-modifying anti-rheumatic drugs (DMARDs) are drugs that work slowly to modify the course of inflammatory disease. Different DMARDs may be useful for a number of different forms of arthritis, including rheumatoid arthritis, lupus and psoriatic arthritis, all of which can affect the ankles. 

Gout medications. Some medications for gout are designed to reduce levels of uric acid in the blood to help prevent future attacks of joint pain and inflammation. Others are designed to relieve the pain and inflammation of an acute attack. Many people with gout take both types of medication.

Biologic response modifiers. The newest category of medications used for rheumatoid arthritis and a few other inflammatory forms of arthritis are the biologic agents. There are currently eight such agents approved by the FDA. Each blocks a step in the inflammation process without suppressing the entire immune system. In addition to rheumatoid arthritis, certain biologic agents may be used in juvenile arthritis, ankylosing spondylitis and psoriatic arthritis.

Osteoporosis medications. Osteoporosis medications are those used to slow the loss of bone or help the body build new bone. Although they are not used specifically to treat ankles, strong bones are less prone to fracture. Osteoporotic ankle fractures are not common, but they can occur.