Arthritis of the lower extremities is an inflammatory disease that affects the joints. Its occurrence can be an independent process or as a consequence of existing infectious foci in the human body, as well as autoimmune and metabolic changes.
The inflammatory process in the joints has common features with similar processes occurring in any other parts of the body. Redness and swelling develop in the tissues surrounding the affected joint. In addition, symptoms appear that indicate the development of a destructive process in the joint. If not properly treated, such disorders can cause disability.
Causes of arthritis of the lower extremities
The disease is based on the following deviations:
- The spread of a viral or bacterial infection in the tissues forming the joint.
- Consequences of an infectious disease. This type of arthritis is called reactive.
- Autoimmune disorder in the body. In this case, the cells of the immune system - antigens begin to attack the body's own cells, identifying them as foreign. This type includes rheumatoid arthritis.
- Patients suffering from psoriasis are often diagnosed with psoriatic arthritis.
- The juvenile rheumatoid form of the pathology almost always takes a chronic course.
- Ankylosing spondylitis. Despite all the efforts of scientists, it has not yet been possible to establish the cause of this form of arthritis.
- Patients with gout develop gouty arthritis due to metabolic disorders.
The disease may occur as a result of:
- surgery performed on the joint;
- severe bruise;
- disturbances in the functioning of the immune system;
- due to an infection with high pathogenicity;
- excessive loads on the joints, for example, when performing heavy physical work.
Bad heredity plays a role. The likelihood of inflammation in the joints of the legs is higher in patients whose relatives already have patients suffering from a similar illness.
Signs and symptoms
Rheumatoid arthritis can develop gradually or very quickly. Signs and symptoms can vary greatly between individuals and can range from mild to very severe. Rheumatoid arthritis is characterized by periods of remission (no symptoms) and exacerbation or “flare” (when symptoms are severe). Sometimes there is an obvious cause for a flare-up (physical or emotional stress, illness), but usually there is no obvious trigger. The course of the disease is individual for each patient and it is impossible to predict the development of the disease.
Fatigue can be one of the symptoms of rheumatoid arthritis that is difficult for people to cope with. Other symptoms may include:
- Joint pain (the main symptom of rheumatoid arthritis)
- Swelling of the joint (often accompanied by redness and increased temperature in the area)
- Joint stiffness (usually worse in the morning and after periods of rest)
- Muscle pain
- Mild fever
- Loss of appetite
- Skin and nail changes
- Anemia may also occur, often exacerbating feelings of fatigue and a general feeling of ill health.
Because rheumatoid arthritis is a systemic disease (meaning it can affect the entire body), symptoms can be similar to having the flu. Rheumatoid arthritis can cause problems in other parts of the body. These include:
- Inflammation of blood vessels (vasculitis)
- Inflammation of the mucous membrane of the lungs or heart
- Dry eyes and mouth.
About a quarter of people with rheumatoid arthritis develop small, hard, movable lumps under the skin called rheumatoid nodules. They usually appear under the skin around joints and on the tops of the arms and legs. Rarely, rheumatoid nodules can occur on the tissue membranes that cover the lungs and on the lining of the brain and spinal cord. Rheumatoid nodules usually do not cause any problems and usually do not require treatment.
About one in six people with rheumatoid arthritis develop significant joint deformity as a result of damage to cartilage, bone, and supporting structures such as ligaments and tendons.
Treatment of arthritis of the foot and lower extremities
In the initial stages of inflammation, including arthritis of the foot, treatment is carried out using medications that should eliminate the effects of inflammation and severe pain, taking into account the initial signs of changes in bone tissue and cartilage.
In our clinic it is possible to detect the presence of inflammatory processes in the joints of the legs.
Based on the examination results, appropriate treatment is prescribed depending on the stage of arthritis of the lower extremities. In a state of remission, a rehabilitation course is carried out. arthritis arthritis of the lower extremities arthritis of the feet
Diagnosis of careumatoid arthritis
There is no single test that diagnoses rheumatoid arthritis. In the initial stages, it can be difficult to distinguish rheumatoid arthritis from other forms of connective tissue inflammation, such as gout, systemic lupus erythematosus, fibromyalgia and others. To diagnose rheumatoid arthritis, your doctor will usually do the following:
- Complete medical history, including any family history of rheumatoid arthritis
- Discussion of current symptoms
- Physical assessment, for example: joints, skin, condition of internal organs
- X-ray and/or MRI
- Blood tests
Two types of blood tests are commonly used to diagnose rheumatoid arthritis:
Immunological tests.
These tests evaluate the levels of proteins and antibodies in the blood, including a protein called rheumatoid factor (RF), antinuclear antibodies (ANA), and sometimes other antibodies. Rheumatoid factor is present in 80% of people with rheumatoid arthritis.
Markers of inflammation
Blood tests may be done to assess erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Both markers are typically elevated in people with rheumatoid arthritis and can be a good indicator of the extent of the disease.
Acute venous blockage
Blockage of the venous system is called thrombosis. A pathology such as thrombosis often leads to local disturbances in blood flow, and in advanced forms, to global systemic changes in blood circulation. The deep veins of the legs are at greatest risk - it is in them that blood clots most often form.
Thrombosis (thrombophlebitis) develops against the background of acute or chronic venous insufficiency.
Experts identify the following reasons for the development of this pathology:
— Long standing work
— Genetic predisposition
— Physical inactivity
- Excess weight
— Heavy physical activity, heavy lifting, prolonged work in a standing or sitting position
The appearance of a pathology such as thrombosis is fraught not only with the possibility of trophic damage and blockage, but also with a risk to life - the occurrence of pulmonary embolism. This is due to the possibility of a detached blood clot penetrating into the lung through the bloodstream, which can cause instant death.
Fungal diseases
According to medical statistics and epidemiological studies, in Russia the presence of fungal nail disease can be expected in almost every fifth adult. Moreover, the incidence rate has increased 2.5 times over the past 10 years. Infection in 30% of cases occurs in the family, from a relative with foot or nail fungus. Most often, the infection is transmitted through shared shoes, but sometimes through other household items. Infection occurs with equal frequency in public places: baths, showers, gyms and sports halls, swimming pools. As a rule, the skin of the feet is affected first, and then the nails.
Atherosclerosis of leg vessels
According to statistics, a tenth of the population, mostly elderly, suffers from this disease. The most vulnerable are males over the age of 65 years. However, middle-aged people are also diagnosed with this disease. The insidiousness of atherosclerosis of the lower extremities lies in the fact that only ten percent of the total number of patients report the classic symptoms of this disease. It is worth considering that the mortality rate from atherosclerosis of the lower extremities is quite high : in the UK the mortality rate is 38, and in Russia this figure reaches 61%.
The degree of danger (death in some developed countries) is clearly demonstrated by the table, which presents WHO statistics (atherosclerosis of the legs in comparison with diabetes mellitus).
| Countries | Atherosclerosis of the legs,% | Diabetes,% | Annual losses of the country's budget, $ |
| Nigeria | 11 | 1 | 400 million |
| Pakistan | 22 | 1 | 1 billion |
| India | 28 | 2 | 9 billion |
| France | 31 | 2 | ? |
| China | 33 | 1 | 18 billion |
| Canada | 34 | 3 | 500 million |
| England | 38 | 1 | 2 billion |
| USA | 38 | 3 | ? |
| RF | 61 | ? | 11 billion |
Atherosclerosis of the arteries of the lower extremities is a disease characterized by a decrease in the lumen of blood vessels and their subsequent blockage. This entails tissue ischemia due to deterioration of peripheral circulation. Tissue nutrition is disrupted, which can lead to necrosis (gangrene).
If left untreated for 5 years, this disease is fatal in 30% of cases. The main causes of death for such patients are stroke (about 12%) and heart attack (about 60%).
In 10–40% of patients, lower limbs are amputated within the first year after diagnosis. In the first year after amputation, mortality reaches 20%, over the next 5 years - 40 - 70%, and after 10 years - 80 - 95%.
In 50% of cases, atherosclerosis of the legs does not manifest itself in any way and is diagnosed only with additional examination. After 50 years, it is present in every fifth inhabitant of the planet. If treatment for atherosclerosis of the lower extremities is not started in a timely manner, surgical intervention with amputation of the leg will be required.
Vascular diseases of the legs:
- Atherosclerosis of the blood vessels of the legs (chronic disease of the arteries, as a result of which cholesterol is deposited on the walls of blood vessels; this is the main provocateur of coronary heart disease)
- Endarteritis (a disease that affects the arteries of the lower extremities and is characterized by an imperceptible contraction of blood vessels until complete blockage, resulting in tissue necrosis that is deprived of blood supply)
- Varicose veins (the flexibility of the veins is lost, they stretch, bulge, due to disruption of the functioning of the venous valves, resulting in reverse blood flow in the veins)
- Acute obstruction of the arteries of the extremities (a disease that occurs against the background of changes in the walls of the artery, as well as other vascular diseases - embolism, thrombosis)
- Acute venous occlusion is a disease characterized by the formation of blood clots (thrombi) in the veins, mainly of the legs.
According to WHO statistics, 25% of women and 15% of men over the age of 30 suffer from foot diseases associated with wearing uncomfortable shoes. Based on this ratio, in the Russian Federation there are 12.8 million such women and 7.7 million men.
According to WHO statistics, 80% of the population suffers from various foot diseases. More than 45% of adults (in the world) suffer from flat feet alone. Based on this ratio, 96.8 million people suffer from foot diseases in the Russian Federation, of which at least 55 million suffer from flat feet.
Foot injuries
Characteristic primarily in sports (running, football, tennis, figure skating, etc.). Statistics on occupational injuries for individual parts of the body (feet) are not kept.
Every tenth fracture and every third closed fracture occurs in the foot (for military personnel this figure is slightly higher and amounts to 13.8% in peacetime).
The most common foot fractures are:
- talus - less than 1%, of which about 30% of cases lead to disability;
- heel - 4%, of which 83% - as a result of a jump on straight legs from a great height;
— cuboid — 2.5%;
— scaphoid — 2.3%;
- metatarsal - the most common type of injury to the bone of the foot.
Moreover, for athletes, a fracture of the fifth metatarsal bone is typical under excessive loads, and for people experiencing unusual excessive loads, often in uncomfortable shoes, a fracture of the second, sometimes 3 or 4, and rarely 1 or 5.
The average duration of disability for a toe injury is 19 days.
A fracture of the foot bones can occur for several reasons:
- heavy objects falling on the foot;
- jump (fall) from a great height and land on your feet;
- when kicked;
- when hit on the leg;
- with subluxation of the foot due to walking on uneven surfaces.
Why is it dangerous?
— Decreased quality of life
– A chronic infectious disease that steadily destroys nails and threatens to spread to surrounding people, especially family members of the patient.
- Untreated mycosis of the nails and mycosis of the feet are considered as an entry point for other infectious diseases - for example, bacterial - erysipelas.
— Complicates the course of diabetes mellitus and can lead to serious complications.
— Allergization of the human body with a fungal infection is the formation of hypersensitivity to the fungus as an allergen, that is, fungal allergy.
— Development or worsening of diseases such as bronchial asthma, allergic dermatitis, various skin rashes and reactions.
- In rare cases, against the background of immunodeficiency, untreated nail fungus led to the development of deep mycosis - germination or penetration of the fungus with blood into the internal organs, which caused death.
Flat feet
According to RNIMU (Russian National Research Medical Institute) named after. Pirogov, from 40 to 60% of the Russian population are susceptible to flat feet . Of these , there are 4 times more women than men .
According to medical statistics from ROSZDRAVA: - by the age of two, 24% of children show the first signs of flat feet, - by the age of four - in 32%, - by the age of six - in 40%, - by the age of twelve - 50% (every second teenager is diagnosed with flat feet ), - by the age of twenty - 60% .
Flat feet can be either congenital or acquired.
Congenital flatfoot in its “pure” form is rarely observed - in approximately 5% of cases . Acquired flatfoot is more common .
Of all cases of acquired flatfoot, transverse flatfoot is in first place in frequency ; it is diagnosed in approximately 65% of cases. In second place in the frequency of detection (about 33% of cases) is longitudinal flatfoot with concomitant flatness of the forefoot. Longitudinal flatfoot is usually combined with hallux valgus . The frequency of this pathology is about 11% of all foot diseases.
Phlebeurysm
In developed countries, the incidence of varicose veins is 25-33% among women and 10-20% among men. In Russia alone, more than 38 million people are officially registered as suffering from various forms of varicose veins, of which 15% have trophic disorders. The number of people with vein diseases increases annually by 2.5%. The “national” feature of varicose veins among our compatriots is the predominance of advanced and complicated forms.
The main causes of varicose veins are:
- congenital weakness of connective tissue,
- hormonal changes
- prolonged forced position sitting or standing.
The pumping of blood back to the heart is supported by the action of valves inside the veins. The valves allow blood to flow in only one direction, preventing venous blood from flowing back into the legs. If the valves do not close correctly, blood flows back into the legs. The venous pool of the legs becomes stretched, due to increased pressure - varicose veins develop.
Severe varicose veins cause a feeling of heaviness in the legs, pain, swelling, and in extreme cases, the appearance of open wounds and ulcers.
Varicose veins develop in the superficial vein system and lead to the development of complications such as inflammation, varicose veins, hemorrhages and ulcers on the legs.
If the disease develops in the deep vein system, it leads to serious disturbances in the outflow of blood and the development of chronic venous insufficiency in the long term. Deep vein disease includes thrombosis and associated complications such as pulmonary embolism (or blood clot rupture) and chronic degradation of venous valves.
If diseases of the superficial or deep veins are not treated, chronic venous insufficiency (CVI) develops. It begins with swelling of the legs, progresses to changes in skin color, and eventually leg ulcers open.
Radical treatment methods, regardless of the techniques, generally boil down to one thing - exclusion of the affected vein from the circulatory system (surgical removal, gluing the lumen of the vein with a laser or a special chemical, etc.).
Acute obstruction of the arteries of the extremities
The consequences of acute arterial obstruction are severe. According to domestic and foreign authors, the development of acute occlusion of the aorta and main arteries of the extremities leads to the death of 20-30% of patients, in 15-25% of cases treatment ends with amputation of the extremities. In some reports, the mortality rate reaches 41% and even 64.5%.
Despite the successful development of vascular surgery in recent decades, the sad statistics on acute arterial obstruction do not have a significant tendency to improve. The main causes of acute arterial obstruction are embolism 57% and acute thrombosis 43%. The incidence of acute arterial obstruction tends to increase
Acute arterial obstruction (AAO) is a collective concept that includes embolism, thrombosis and arterial spasm:
Embolism is the separation of a blood clot from the site of its initial formation, its transfer through the vascular bed with the blood flow and subsequent blockage of the artery.
Acute thrombosis is a sudden cessation of arterial blood flow caused by the development of a blood clot at the site of a vascular wall changed as a result of disease or injury.
Spasm is a functional condition that develops in arteries of muscular and mixed type in response to external or internal provoking moments (direct or indirect injury, fractures, etc.)
The main treatment for the disease is emergency surgery.
