Bernd L. asks about "Activated osteoarthritis": I am 71 years old, of normal weight and cycle two or three times a week on a road bike or MTB. I have had osteoarthritis in my left ankle for many years, cycling is fine, but walking is only possible with pain. I have now been diagnosed with "activated osteoarthritis". I could no longer walk and was hospitalised with infusions. After that, the inflammation was gone, but the pain remained. What other treatment options are there before I have to think about an operation?
Answer from Dr Christian Merkl: In osteoarthritis (joint wear and tear), the cartilage coating of the joint surfaces involved wears away. In addition, the joint capsule can shrink and the position of the joint can deviate from the normal axes. As a result, it is usually no longer possible to move it well and completely, and it is less resilient. Osteoarthritis is called "activated" when joint effusion forms as a result of overloading and the joint becomes inflamed - the capsule swells and hurts. This is often associated with so-called bone marrow oedema, an increased accumulation of fluid in the bone.
The degree of increased osteoarthritis activity is categorised into three stages, according to which the therapy should be based: In stage 1, short-term pain-relieving and anti-inflammatory rheumatism medication is given. Physiotherapy for mobilisation and possibly insoles to correct the axis are also helpful. In stage 2, injections of hyaluronic acid, polynucleotide gel and a protein solution obtained from the patient's own blood can be used. In stage 3, the ankle joint should initially be immobilised and the foot position corrected, for example with orthopaedic shoes or an orthosis.
Only if all this remains unsuccessful are surgical measures such as arthroscopy, partial or complete fusion or a prosthesis considered. In all phases, I consider it necessary to train the muscles surrounding the joint, if possible without body weight and without compressing the affected section. Continue to do adapted training on the bike, as this will help you maintain the residual function of the joint.
