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<Provider Id="sundheddkcms"> <Item Id="{1716D5DB-342E-4377-B98C-C762B238016C}" Name="artrose-ankel" Type="LHContentPage" ParentProviderId="sundheddkcms" ParentItemId="{AEB4ECE5-3040-426F-9E18-375AFD4D8112}" SortOrder="0" PublishDate="2009-09-07T13:02:00" DeleteDate="2999-12-31T00:00:00" PotItemType=""> <Content> <HtmlField Name="PageContent"><![CDATA[<h2>Diagnose</h2> <h3>Diagnostiske kriterier</h3> <ul> <li>Diagnosen er klinisk og bekræftes ved røntgen</li> <li>Røntgenforandringerne korresponderer ikke altid med de kliniske symptomer</li> </ul> <h3>Sygehistorie</h3> <ul> <li>Belastningssmerter og stivhed i ankelleddet</li> <li>Generne opstår under aktivitet, men kan progrediere med mere vedvarende hvilesmerter</li> <li>Specielt vil gang på hårdt eller ujævnt underlag forværre smerterne</li> <li>Patienten kan ofte fortælle om en tidligere ankelskade</li> </ul> <h3>Kliniske fund</h3> <ul> <li>Hævelse i ankelleddet, kapselsvulst, ømhed og nedsat bevægelighed</li> <li>Ikke sjældent er der muskelsvind i læggen</li> <li>Oftest stiv afvikling i fodafsættet</li> </ul> <h3>Supplerende undersøgelser i almen praksis</h3> <ul> <li>Ingen ud over grundig klinisk undersøgelse inklusive vurdering af pulsforhold</li> </ul> <h3>Andre undersøgelser hos specialist</h3> <ul> <li>Røntgenundersøgelse viser typiske artroseforandringer; reduceret bruskhøjde, subkondral sklerosering og osteofytdannelse</li> </ul> <h3>Differentialdiagnoser</h3> <ul> <li>Inflammatorisk ledlidelse og traumesequelae</li> </ul> <h2>Behandling<a href=" " data-type="journal-reference" data-value="Hayes BJ, Gonzalez T, Smith JT, Chiodo CP, Bluman EM, Ankle Arthritis: You Can't Always Replace It. J Am Acad Orthop Surg 2016;24: e29-38" data-value-piped="Hayes BJ, Gonzalez T, Smith JT, Chiodo CP, Bluman EM|Ankle Arthritis: You Can't Always Replace It.|J Am Acad Orthop Surg|2016|24|e29-38|26660651" data-url="reference-link" data-pubmedid="26660651" title="Hayes BJ, Gonzalez T, Smith JT, Chiodo CP, Bluman EM, Ankle Arthritis: You Can't Always Replace It. J Am Acad Orthop Surg 2016;24: e29-38">1</a><sup>,</sup><a href=" " data-type="journal-reference" data-value="Bloch B, Srinivasan S, Mangwani J, Current Concepts in the Management of Ankle Osteoarthritis: A Systematic Review. J Foot Ankle Surg 2015;54: 932-9" data-value-piped="Bloch B, Srinivasan S, Mangwani J|Current Concepts in the Management of Ankle Osteoarthritis: A Systematic Review.|J Foot Ankle Surg|2015|54|932-9|26028603" data-url="reference-link" data-pubmedid="26028603" title="Bloch B, Srinivasan S, Mangwani J, Current Concepts in the Management of Ankle Osteoarthritis: A Systematic Review. J Foot Ankle Surg 2015;54: 932-9">2</a></h2> <h3>Behandlingsmål</h3> <ul> <li>Symptomlindring</li> </ul> <h3>Håndtering i almen praksis</h3> <ul> <li>Forsøg konservativ behandling med eventuet vægttab, modificering af aktivitetsniveau, hvor patienten undgår aktiviteter, der udløser smerterne samt brug af håndkøbsanalgetika</li> </ul> <h3>Råd til patienten</h3> <ul> <li>Sko med tilbagelagt gænge tilpasset bevægeudslaget i anklen</li> <li>Skoens sål er konstrueret, så patienten får reduceret dorsalflektion i anklen</li> <li>En fast støvle omkring ankelleddet med gængesål er også effektiv</li> <li>Støddæmpende indlæg kan lindre smerten</li> </ul> <h3>Medicinsk behandling</h3> <ul> <li>Svage analgetika <ul> <li>Anbefales som første valg i perioder med smerter</li> </ul> <ul> <li>F.eks. [DliActiveSubstance;6381;paracetamol] tbl. 500 mg: 1 g x 3 i 1-4 uger</li> </ul> </li> <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/213010">NSAID</a> <ul> <li>Kan være nyttige som supplement i perioder med mange smerter, men langvarig behandling bør undgås. Især hos ældre bør NSAID kun bruges undtagelsesvist </li> </ul> </li> <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/grupper/215000">Lokalvirkende NSAID</a>? <ul> <li>Har kortvarig effekt, men effekten forsvinder efter længere tids behandling</li> </ul> </li> <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/171050">Steroidinjektioner</a> kan have effekt, men gentagne injektioner bør undgås</li> </ul> <h3>Operativ behandling</h3> <ul> <li>Artroskopi med fjernelse af osteofytter kan give forbedret funktion ved forreste impingement</li> <li>Artrodese med operativ stivgøring har god effekt på smerterne i anklen, men kræver specielle sko som kan kompensere for manglende bevægeudslag i ankelleddet</li> <li>Ankelprotesekirurgi har igennem flere årtier været anset som eksperimentel behandling ved artrosepatienter, men nyere proteser tilbydes nu til udvalgte patienter. Et særligt problem er forholdsvis høj risiko for løsning af protesekomponenterne, og holdbarheden er stadig ikke på højde med eks. hofte- og knæproteser<a title="Jeyaseelan L, Si-Hyeong Park S, Al-Rumaih H, Veljkovic A, Penner MJ, Wing KJ, Younger A, Outcomes Following Total Ankle Arthroplasty: A Review of the Registry Data and Current Literature. Orthop Clin North Am 2019;50: 539-548" href="EditorPage.aspx?da=core&id=%7B1716D5DB-342E-4377-B98C-C762B238016C%7D&ed=FIELD9067189363&vs&la=da&fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&di=0&hdl=H9067189421&us=sitecore%5Canvi&mo&pe=0&fbd=1" data-type="journal-reference" data-value="Jeyaseelan L, Si-Hyeong Park S, Al-Rumaih H, Veljkovic A, Penner MJ, Wing KJ, Younger A, Outcomes Following Total Ankle Arthroplasty: A Review of the Registry Data and Current Literature. Orthop Clin North Am 2019;50: 539-548" data-value-piped="Jeyaseelan L, Si-Hyeong Park S, Al-Rumaih H, Veljkovic A, Penner MJ, Wing KJ, Younger A|Outcomes Following Total Ankle Arthroplasty: A Review of the Registry Data and Current Literature.|Orthop Clin North Am|2019|50|539-548|31466669" data-url="reference-link" data-pubmedid="31466669">3</a></li> </ul> <h3>Forebyggende behandling</h3> <ul> <li>Ingen kendte bortset fra at forvridninger ved sportsaktivitet så vidt muligt bør forebygges</li> </ul> <h2>Henvisning</h2> <ul> <li>Patienten bør henvises til ortopædkirurg, når der foreligger hvile- eller natlige smerter, samt når der opstår kontrakturer som vanskeliggør gangen</li> </ul> <h2>Opfølgning</h2> <ul> <li>Almen praksis ved konservativ behandling og hospital efter operation</li> </ul> <h2>Sygdomsforløb, komplikationer og prognose</h2> <h3>Sygdomsforløb</h3> <ul> <li>Tilstanden progredierer ofte gradvist</li> </ul> <h3>Komplikationer</h3> <ul> <li>Normalt ingen bortset fra at svær slidgigt kan medføre fejlstilling af anklen og tryksår</li> </ul> <h3>Prognose</h3> <ul> <li>Er som ved alle former for slidgigt præget at normalt progredierende symptomer med perioder med forværring</li> </ul> <h2>Baggrundsoplysninger</h2> <h3>Definition</h3> <ul> <li>Degenerative ledforandringer i ankelleddet </li> </ul> <h3>Forekomst</h3> <ul> <li>Artrose i anklen er mindre hyppigt end artrose i knæ- og hofteled </li> <li>Almindeligvis ensidig</li> </ul> <h3>Ætiologi og patogenese</h3> <ul> <li>Primær artrose i talokruralleddet er sjælden<a href=" " data-type="journal-reference" data-value="Delco ML, Kennedy JG, Bonassar LJ, Fortier LA, Post-traumatic osteoarthritis of the ankle: A distinct clinical entity requiring new research approaches. J Orthop Res 2017;35: 440-453" data-value-piped="Delco ML, Kennedy JG, Bonassar LJ, Fortier LA|Post-traumatic osteoarthritis of the ankle: A distinct clinical entity requiring new research approaches.|J Orthop Res|2017|35|440-453|27764893" data-url="reference-link" data-pubmedid="27764893" title="Delco ML, Kennedy JG, Bonassar LJ, Fortier LA, Post-traumatic osteoarthritis of the ankle: A distinct clinical entity requiring new research approaches. J Orthop Res 2017;35: 440-453">4</a></li> <li>Sekundær artrose ses hyppigt, fordi selv en ringe fejlstilling i leddet vil give stor og unormal belastning på ledbrusken </li> <li>Årsager kan være <ul> <li>Underbensbrud med aksefejl </li> <li>Dårligt reponerede malleol fraktur </li> <li>Aseptisk talusnekrose eller </li> <li>Kronisk instabilitet i talokruralleddet</li> </ul> </li> </ul> <h3>Disponerende faktorer</h3> <ul> <li>Overvægt </li> <li>Tidligere fraktur som har medført inkongruens i leddet </li> <li>Tidligere sygdom som har beskadiget ledbrusken, f.eks. <a href="~/link.aspx?_id=939AB6BE2EA74C2890648DEA4AF5E6C6&_z=z">reumatoid artrit</a> </li> <li>Fejlstillinger i anklen</li> </ul> <h3>ICPC-2</h3> <p>[ICPC]</p> <h3>ICD-10/SKS-koder</h3> <p>[ICD10]</p> <h2>Patientinformation</h2> <h3>Hvad findes der af skriftlig patientinformation</h3> <ul> <li><a href="~/link.aspx?_id=C986CBB90C3E470397DB6A55E7D944AC&_z=z">Ankelartrose</a></li> <li><a href="https://hmi-basen.dk/news.asp?newsid=12913&x_newstype=39">Hjælpemiddelbasen, Gigt</a></li> </ul> <h3>Træningsfilm for underben og fod</h3> <ul> <li><a href="~/link.aspx?_id=1F6D4E5CBD3F4692BA93BE7541182DB7&_z=z">Øvelsesprogram, 3 øvelser</a><br> <br> <a href="~/link.aspx?_id=66FD9B729628437E98D9A0A38C191DB8&_z=z"><img alt="" src="E5F85279BD074A85A25EAE999BECACD2-135-84" style="height: 84px; width: 135px;" height="84" width="135"></a></li> </ul> <h2>Link til vejledninger</h2> <ul> <li>Ingen relevante</li> </ul> <h2>Illustrationer</h2> <h3>Billeder</h3> <ul> <li> <a href="~/link.aspx?_id=496726764C1747A88D94F5B257041F24&_z=z">Ankelartrose, sidebillede</a> </li> <li> <a href="~/link.aspx?_id=500A222084864BA58F8A28568121B4CB&_z=z">Ankelartrose, skrå</a> </li> <li> <a href="~/link.aspx?_id=A18B859BA2F348BA9B36B3A8B9E048BE&_z=z">Ankel, sidebillede, rtg. normale fund</a> </li> <li> <a href="~/link.aspx?_id=68D85018D91C44B5AA519392BEE2805C&_z=z">Ankel, skråbillede, rtg. normale fund</a> </li> </ul> <h3>Plancher eller tegninger</h3> <ul> <li> <a href="~/link.aspx?_id=233E7E060137411998A08AD07C7EC3A4&_z=z">Ankelskelet lateralt, tegning</a> </li> <li> <a href="~/link.aspx?_id=28EC78DBFC9440A0A9832D1CBF9D6FC2&_z=z">Ankelskelet bagfra, tegning</a></li> </ul>]]></HtmlField> <HtmlField Name="Resume"><![CDATA[<h2>Resumé</h2> <h3>Diagnose</h3> <ul> <li>Typisk anamnese med triadesmerter i anklen</li> <li>Diagnosen er primært klinisk</li> <li>Røntgenundersøgelse bekræfter den kliniske diagnose</li> </ul> <h3>Behandling</h3> <ul> <li>Primært konservativ med modificering af aktivitetsniveau, vægttab og håndkøbsanalgetika</li> <li>Sko med gængesål og støtte omkring anklen kan ofte have virkning</li> <li>Ved manglende effekt af konservativ behandling operation med stivgøring eller alloplastik</li> </ul> <h3>Henvisning</h3> <ul> <li>Når konservativ behandling ikke har effekt</li> <li>Hvis diagnosen er uklar</li> </ul>]]></HtmlField> <LinkListField Name="Spot2"> <LinkField 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AuiNkh+I/8UyioA/4p4Jjkw48gqQBDETlFbd+R9Kt9PdL7zOllbH/AI/IxBBLGvfhLM0saN/l+n8P7PHKtPoRi2BMofw45+rg/qy+v/N4kyzksHvfza/Jb8qtNurPyhXX9bnJaZopnn9WXb4p71+acT/LBz+L/da5m8Au6DRbxf8AM/8AxB57gP5kQ3cmp6XRYb2z256Xx/3X6a9IAx+JvtfF6js/PnmDg1tZfBy+jL/k/wCZlj/R/pMzHaxyeaMoA279M2JYBmPlP8vrrU2iu75WS3BDLbqpLPQ1HM/srmNkzjo5EMPe9hg0aUKtIiDQbcSAPoGY5m38Ka2ljLF+w5J6niciZp4UzS3egPB/+BpjxrwvTdFSn5cyLQ/7y3e3fdpMyon0W40h63//1u/+enVBZVBLH1aAf7Dc5Rm6N2JiaThhyDbD8Mxm+lUSScQwKsp3qDhVsXI4hqihPWvjg4lpxcFtwK9aE9flhtaX8ojGGJ+E9CDX78NilpTuLO2lAVgAW+yRRgfuxQ8q/PLTdV07yqsukgCKeb0tTdCeawMvw0/yGf4ZT/LmRhq92nJdbPnaWJwaVHyX7OZhcZTWOm/fAln/AOTGr69p3mtjp9jNf6XfQSW+q2yLWKVCp4ci37vkrfD/AKrMuajtnSjPioHhyQkJY5/zHI020v6LM/Jv5GTWt3Jqesxqv71ms9ORuXpxliVUtSjFV2y+eWRiO/8Ai/pNkMYBevWGkRQQqiKYUUbKVA/VlQ3bCiWSWNTxQP8A5IBB+/E2FFNosx3MJT6R/HAL7kmu9XoOPxD8Bk6Ysy0sL/g1x29G4/4k+ZMfoceX1v8A/9fvfn9ORsNq/wB9/wAaZjajo34OrExF2oPnmLu5GziFU0Iqev2eX34VXBgR/d0+QOH4IcRXb8CK/rGCkgqgLgdAR3Q7g4d1VbYsrs4CgkUox3xjsiSnqdjbahbPBdxRyxOCrqSCCDsckSUB55N+QH5eSytJ6M8QZuRjiuCq79gN9skM0x1Y+HHuRtj+SP5Z2jcv0Qty3X/SZ3k/AkYnLM9V8OPczGwsNP02FYLGzgtoIxRIoQqgfQMrJZ0rmZx+wv8AwQx4lpY87gfYA+kY8RTwrPWlO6x8qeBrg4ivC71pf98Nh4j3LwtGWTvA/wCOPEe5aZtpbN/gp2KEH0Ln4D16vmXH+7caQ9b/AP/Q9BedpRGbKrha+r17/YyrKW3GGK/WYiaetX5f7WUcTbS71oqf3j/RXGwtNieGlP3nyxsJpyzwKKFXBPXcf1wWFouE0A6ISQe7DBYTSslsp+Jk+JtzXHhC2u+rx/ybY8IW3CCOv92MeELbhbxA7RjfHhC2XfVo6fYH348IW2jbpWvpiuPCFtYbZa/YGPCm1kqegoZQVrseIyJFJG6HW65mgPI+DsqYBJJCtxuD0ZPoYn9WTosbDMdNDf4QcVHL0bjfenV8yYj0OPL63//R71+YNKWP8377jX7P7HXMbUdG/B1YknDh8P2/etMxejkL/wBzzStONPi65LdC7936rUpw/ZrgPNejbcODcac67dK09q/xxKVWL0+SceP+Xz8e1MI8kFEHnyPDnTvzrT6O+SN3shcvr9q8f8utP64i07O+Om1a+1afjjujZsc+/Kv047q3+9p8PX35Yd12ab61T4ePvWtcB4l2WH6z24+/XB6k7KL+vXev+w/twbp2bX0OJ506/t9a+9ckKQbUT9SqePDn/k1rX6MfSjdmum0/wc9OnoXHj4vmVH6HHl9b/9k=]]></Media> 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