ANKLE JOINT DISORDER

AMELINE NECIA 07 139 FK UKI 2011

Pembimbing : dr Andre Sihombing

DAFTAR ISI I. II. Pendahuluan Tinjauan Pustaka Definisi Anatomi Epidemiologi Etiologi Patofisiologi Gejala klinnis Penatalaksanaan Prognosis Penutup Kesimpulan Saran

III.

ANATOMI Pergelangan kaki terdiri dari ujung-ujung tulang kering serta tulang betis dan tumit. Tulang-tulang itu disatukan oleh ligamen yang cukup kuat, sehingga membentuk sendi. Berikut ini cara merawat persendian tersebut agar tidak mudah cedera. Sendi pergelangan kaki dapat menjadi stabil karena adanya bungkus sendi dan ligamen yang kuat. Sendi pergelangan kaki sering mengalami cedera. Padahal, persendian ini harus dapat berfungsi dengan baik karena sangat diperlukan waktu kita berolahraga atau melakukan aktivitas fisik yang lain. Sendi pergelangan kaki harus mendapat perhatian yang cukup agar tidak mudah mengalami cedera. Salah satu usaha untuk menguatkannya adalah dengan melatih yang terlibat secara aktif dalam menggerakkan sendi pergelangan kaki.

Joint disorder is a general term describing any abnormal condition that involves any aspect of a joint. A joint occurs any place where two elements of the skeleton meet. Joint disorders can be caused by infection, inflammation, chronic repetitive injury, acute injury, degeneration, congenital deformity, and neoplasm. Many diseases and conditions fall under the heading of joint disorder. A list compiled by the American College of Rheumatology contains more than 190 disorders that cause musculoskeletal pain and stiffness. Examples of joint disorders include osteoarthritis, systemic lupus erythematosus (SLE), ankylosing spondylitis, Behet's syndrome, gout, infectious (septic) arthritis, rheumatoid arthritis, Felty's syndrome, and patella chondromalacia. Joint disorders may be associated with diseases such as regional enteritis or ulcerative colitis. Other joint disorders may involve tightening or shrinking of the joint capsule (frozen joint, joint contracture), which may occur following surgeries involving the joint (e.g., arthroscopy, arthroplasty) or after prolonged periods of immobility. Certain joint disorders may involve increased fluid within the joint (joint effusion), which results in distension of the joint capsule and swelling within the joint. Causes of joint effusion include inflammation, infection, intra-articular hemorrhage (hemarthrosis), acute trauma, joint disease, and overuse of the joint. Arthritic conditions differ from joint disorders caused by structural problems (e.g., improper loading on the joint due to muscle imbalances) in that periods of acute swelling and pain within the joint may briefly subside, only to recur. Joint disorders such as rheumatoid arthritis (a systemic autoimmune response that targets joints) are increasingly debilitating and cause permanent joint damage. Risk: The risk for chronic joint disorders increases with age, obesity, traumatic joint injury, hereditary factors, repetitive activities, and participation in impact sports. Chronic arthralgia (pain in a joint) and frozen shoulder syndrome (adhesive capsulitis) are more common in women than in men and are most common in individuals ages 40 to 70 ("Pearsall"). Osteoarthritis (inflammation in a joint) is more common in women than in men and affects more than 70% of individuals between the ages of 55 and 78 ("Wilkie"). Rheumatoid arthritis also is more common in women than men ("Matsumoto"). Incidence and Prevalence: Arthralgia is a very common symptom that affects nearly everyone at some time during life. Nearly 1 in 3 adults in the US is affected by arthritis and chronic joint disorders, and nearly 1 in 20 working adults between the ages of 18 and 64 report work limitations from joint symptoms (Arthritis). In the US, incidence of knee osteoarthritis is 240 per 100,000 population; 100 per 100,000 for hand osteoarthritis; 88 per 100,000 for hip osteoarthritis, (Arthritis Types); 70 per 100,000 for rheumatoid arthritis (Matsumoto). Adhesive capsulitis has a lifetime prevalence of up to 3% of the population, occurring most frequently after a period of shoulder immobilization (Pearsall). Joint contractures

of the shoulders, elbows, hips, knees, and ankles occur in up to 34% of individuals spending more than 6.6 weeks in an intensive care unit (ICU) (Clavet).

PENATALAKSANAAN Stretching of the Achilles tendon Strengthening of the surrounding muscles Proprioceptive training: balance exercises and agility Wearing proper footwear and or tape when appropriate

Ankle pain
Ankle pain involves any discomfort in one or both ankles.

Causes
Ankle pain is often due to an ankle sprain.

An ankle sprain is an injury to the ligaments, which connect bones to one another. In most cases, the ankle is twisted inward, causing small tears in the ligaments. The tearing leads to swelling and bruising, making it difficult to bear weight on the joint.

In addition to ankle sprains, ankle pain can be caused by:

Damage or swelling of tendons (which join muscles to bone) or cartilage (which cushions joints) Infection in the ankle joint Osteoarthritis, gout,rheumatoid arthritis, Reiter syndrome, and other types of arthritis

Problems in areas near the ankle that can cause you to feel pain in the ankle include:

Blockage of blood vessels in the leg Heel pain or injuries Nerve injuries (such as tarsal tunnel syndrome or sciatica)

Home Care
To treat an ankle sprain:

Rest your ankle for several days. Try NOT to put much weight on your ankle. Put on an ACE bandage. You also can buy a brace that supports your ankle. Use crutches or a cane to help take the weight off a sore or unsteady ankle. Keep your foot raised above the level of your heart. When you are sitting or sleeping, place two pillows under your ankle. Ice the area right away. Apply ice for 10-15 minutes every hour for the first day. Then, apply ice every 3-4 hours for 2 more days. Try acetaminophen or ibuprofen for pain and swelling.

As the swelling and pain improve, you will need to keep extra stress off your ankle for up to 10 days for a milder sprain and 2 to 5 weeks for a more severe sprain. The injury may take a few weeks to many months to fully heal. Once the pain and swelling are mostly gone, the injured ankle will still be a little weaker and less stable than the uninjured ankle.

You will need to start exercises to strengthen your ankle and avoid injury in the future. Do not begin these exercises until a health care professional tells you it is safe to start. For arthritis and other ankle problems, follw the treatment your doctor recommended.

When to Contact a Medical Professional

Go to the hospital if:

You have severe pain even when you are NOT bearing weight. You suspect a broken bone (the joint looks deformed and you cannot put any weight on the leg). You can hear a popping sound and have immediate trouble using the joint.

Call your doctor if:

Swelling does not go down within 2 - 3 days You have symptoms of infection -- the area becomes red, more painful, or warm, or you have a fever over 100 F The pain does not go away after several weeks Other joints are also involved You have a history of arthritis and are having new symptoms

What to Expect at Your Office Visit

Your doctor will perform a physical examination, including a detailed examination of the ankles, and will ask questions such as:

Does the pain shift from joint to joint? Is the pain the same in both ankles? Did the pain begin suddenly and severely? Did the pain begin slowly and mildly and then get worse? Did the pain get better by itself in less than 6 weeks? Does the ankle feel warm to the touch? Does the ankle hurt when you are not bearing weight on it? Do you have any abnormal sensation in your foot?

Diagnostic tests that may be performed include the following:

Aspiration of synovial fluid (fluid from the joint space) and synovial fluid analysis X-ray of the ankle and possibly the foot

Nonsteroidal anti-inflammatory medications (NSAIDs), special foot gear, or braces may be prescribed. Surgery is sometimes needed.

Prevention

Lose weight if you are overweight. Extra pounds put strain on your ankles. Warm up before exercising. Stretch the muscles and tendons that support the ankle. Avoid sports and activities for which you are not properly conditioned. Make sure that shoes fit you properly. Avoid high-heeled shoes. If you are prone to ankle pain or twisting your ankle during certain activities, use ankle support braces. These include air casts, ACE bandages, or lace-up ankle supports. Work on your balance and do agility exercises.

Ankle replacement
URL of this page: http://www.nlm.nih.gov/medlineplus/ency/article/007254.htm

Ankle replacement is surgery to replace the damaged parts of the three bones that make up the ankle joint. Artificial joint parts (prosthetics) are used to replace your own bones. They come in different sizes to fit different-size people.

Description
Ankle replacement surgery may be done while you are under general anesthesia. This means you will be asleep and pain-free. Or, you may have spinal anesthesia. You will be awake but will not feel anything below your waist. If you have spinal anesthesia, you will also be given medicine to help you relax during the operation. Your surgeon will make a surgical cut in the front of your ankle to expose the ankle joint. Your surgeon will then gently push the tendons, nerves, and blood vessels to the side. After this:

Your surgeon will remove the damaged bone. Your surgeon will reshape three of your bones that will remain in place: o The lower end of your shin bone (tibia) o The lower end of your smaller lower leg bone (fibula) o The top of your foot bone (talus) that the leg bones rest on The parts of the new artificial joint are then attached to the cut bony surfaces. A special glue/bone cement may be used to hold them in place. Often, screws are also placed through the two leg bones (fibula and tibia) to help support the artificial ankle. A bone graft is created between the ends of the fibula and tibia. This makes your new ankle more stable.

After putting the tendons back into place, the surgeon closes the wound with sutures (stitches). You may need to wear a brace for a while to keep the ankle from moving.

Why the Procedure is Performed

Ankle replacement surgery may be done if the ankle joint is severely damaged. Your symptoms may be pain and loss of movement of the ankle. Some causes of damage are:

Arthritis caused by ankle surgery in the past Bone fracture Infection Osteoarthritis Rheumatoid arthritis

Risks
Risks for any anesthesia are:

Allergic reactions to medicines Breathing problems

Risks for any surgery are:

Bleeding Blood clot Infection

Risks for ankle replacement surgery are:

Allergic reaction to the artificial joint Ankle weakness, stiffness, or instability Blood vessel damage Bone break during surgery Dislocation of the artificial joint Loosening of the artificial joint over time Nerve damage Skin not healing after surgery

Before the Procedure

Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription. During the 2 weeks before your surgery:

You may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), and other drugs. Ask your doctor which drugs you should still take on the day of your surgery. If you have diabetes, heart disease, or other medical conditions, your surgeon will ask you to see your doctor who treats you for these conditions. Tell your doctor if you have been drinking a lot of alcohol, more than one or two drinks a day. If you smoke, try to stop. Ask your doctor or nurse for help. Smoking can slow down wound and bone healing. Always let your doctor know about any cold, flu, fever, herpes breakout, or other illness you may have before your surgery. You may want to visit the physical therapist to learn some exercises to do before surgery. The physical therapist can also teach you how to correctly use crutches.

On the day of your surgery:

You will usually be asked not to drink or eat anything for 6 to 12 hours before the procedure. Take the drugs your doctor told you to take with a small sip of water.

Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

After surgery, you will need to stay in the hospital for 3 to 4 days. Your ankle will be in a cast or a splint after surgery. A small tube that helps drain blood from the ankle joint may be left in your ankle for 1 or 2 days. To keep swelling down, keep your foot raised higher than your heart while you are sleeping or resting. Your doctor may recommend physical therapy to teach you exercises that will help you move more easily.

Outlook (Prognosis)
A successful ankle replacement will get rid of your pain and allow you to move your ankle up and down. Usually, total ankle replacements last 10 or more years. How long yours lasts will depend on your activity level, overall health, and the amount of damage to your ankle joint before surgery

Ankle sprain - series

The ankle joint connects the foot with the leg. The ankle joint allows the foot to move upward and downward and in an inward and outward motion. Muscles, tendons, and ligaments surround the ankle providing the stability the ankle joint needs for walking and running. Type I ankle sprain

The most common way the ankle can be injured is by an ankle sprain. When an ankle is sprained ligaments on the ankle are either stretched, partially torn or completely torn. The most common type of sprain is an inversion injury, where the foot is rotated inward. Ankle sprains can range

from mild, to moderate, and severe. Type 1 ankle sprain is a mild sprain. It occurs when the ligaments have been stretched or torn minimally

Type II ankle sprain

Type II ankle sprain is a moderate level of sprain. It occurs when some of the fibers of the ligaments are torn completely.
Type III ankle sprain

Type III ankle sprain is the most severe ankle sprain. It occurs when the entire ligament is torn and there is great instability of the ankle joint.

Foot, leg, and ankle swelling

Painless swelling of the feet and ankles is a common problem, especially among older people.Abnormal buildup of fluid in the ankles, feet, and legs is called edema.

Considerations
Painless swelling may affect both legs and may include the calves or even the thighs. Because of the effect of gravity, swelling is particularly noticeable in the lower part of the body.

Causes
Foot, leg, and ankle swelling is common with the following situations:

Being overweight Blood clot in the leg Increased age Leg infection Veins in the legs that cannot properly pump blood back to the heart

Injury or surgery involving the leg, ankle, or foot can cause swelling. Swelling may also occur after pelvic surgery, especially for cancer. Long airplane flights or car rides, as well as standing for long periods of time, often lead to some swelling in the feet and ankles. Swelling may occur in women who take estrogen or during parts of the menstrual cycle. Most women have some swelling during pregnancy. More severe swelling during pregnancy may be a sign of preeclampsia (also called toxemia), a serious condition that includes high blood pressure and swelling. Swollen legs may be a sign of heart failure, kidney failure, or liver failure. In these conditions, there is too much fluid in the body. Certain medications may also cause your legs to swell:

Antidepressants, including MAO inhibitors (such as phenelzine and tranylcypromine) and tricyclics (such as nortriptyline, desipramine, and amitriptyline)

Blood pressure medicines called calcium channel blockers (such as nifedipine, amlodipine, diltiazem, felodipine, and verapamil) Hormones like estrogen (in birth control pills or hormone replacement therapy) and testosterone Steroids

Home Care
Some tips that may help:

Raise your legs above your heart while lying down. Exercise your legs. This helps pump fluid from your legs back to your heart. Follow a low-salt diet, which may reduce fluid buildup and swelling. Wear support stockings (sold at most drug and medical supply stores). When traveling, take breaks often to stand up and move around. Avoid wearing tight clothing or garters around your thighs. Lose weight if you need to.

Never stop taking any medicines you think may be causing swelling without first talking to your doctor.

When to Contact a Medical Professional

Call 911 if:

You feel short of breath. You have chest pain, especially if it feels like pressure or tightness.

Call your doctor right away if:

You have heart disease or kidney disease and the swelling gets worse. You have a history of liver disease and now have swelling in your legs or abdomen. Your swollen foot or leg is red or warm to the touch. You have a fever. You are pregnant and have more than just mild swelling or have a sudden increase in swelling.

Also call your doctor if self-care measures do not help or swelling gets worse.

What to Expect at Your Office Visit

Your doctor will take a medical history and do a thorough physical examination, paying special attention to your heart, lungs, abdomen, lymph nodes, legs, and feet. Your doctor will ask questions like the following:

What body parts swell? Your ankles, feet, legs? Above the knee or below? Do you have swelling at all times or is it worse in the morning or evening? What makes your swelling better? What makes your swelling worse? Does the swelling get better when you raise your legs? What other symptoms do you have?

Diagnostic tests that may be done include the following:

Blood tests such as a CBC or blood chemistry Chest x-ray or extremity x-ray ECG Urinalysis

The treatment will be aimed at the cause of the swelling. Diuretics may be prescribed to reduce the swelling, but they can have side effects. Home treatment for benign causes of leg swelling should be tried before drug therapy.