Tuberculosis of the foot and ankle

Foot and ankle tuberculosis: case series and literature review

Foot and ankle tuberculosis (TB) is a rare presentation of skeletal TB. The uncommon site along with low index of clinical suspicion in the western world leads to delays in the diagnosis and treatment. This can make joint sparing procedures less successful, especially in the midfoot where the joints can often be interconnected. Plain radiographs have low sensitivity and specificity and cross sectional imaging in the form of MRI or CT is more reliable. Treatment involves the use of multiple anti-tuberculous drugs in the first instance, followed by surgery to address any symptomatic deformity and/or secondary degenerative changes. We present our experience on the management of this rare problem and review the literature on the clinical presentation, diagnosis, imaging modalities and treatment.

Isolated tuberculosis of the calcaneum in a constitutionally well patient

A 66-year-old Caucasian man presented with a 9-month history of a painful left heel with associated soft tissue swelling. Pitting oedema was present to the upper shin. Plain radiograph showed a sclerotic calcaneum with lucent patches and the CT scan revealed bony destruction at the posterosuperior aspect of the calcaneus with a moth-eaten appearance. To obtain a more definitive diagnosis, the patient underwent a CT-guided biopsy, which showed caseating granulomatous inflammation strongly suggestive of Mycobacterium infection. A Ziehl-Neilson stain did not show any microorganisms. Microbiology confirmed the presence of Staphylococcus aureas. A diagnosis of tuberculosis with concomitant Staphylococcus superinfection was made based on the histology and clinical context. The patient was treated with curettage and cementing of the lesion in order to debride the infected tissue and provide structural support to the bone. A 9-month course of quadruple antituberculous therapy was also initiated.

Ankle and foot tuberculosis: a diagnostic dilemma

Aim and Objective:

To know the biological behavior of ankle and foot tuberculosis (AFTB) and to know the reasons for delay in diagnosis and treatment of AFTB in our population.

Materials and Methods:

Patients with non-healing ulcers/sinuses/swellings in the ankle and foot region are the subjects of present study. Detailed clinical history, physical examination and relevant investigations were done in all cases. Pus/wound discharge for acid fast bacillus (AFB) study and biopsy from wound margin/sinus tract was taken in all the cases.

Results:

During the period from July 2007-June 2012, 20 cases of AFTB were treated. Out of them five cases were difficult to diagnose and a mean period of 6 month to 5year was elapsed before final diagnosis was established. Out of these five cases – three cases were diabetic with ulcers and sinuses in the heel and ankle region. One case was wrongly diagnosed as angiodysplasia with A-V malformation of foot and diagnosis was delayed for 5 year. In one case of rheumatoid arthritis with abscess in ankle joint, the diagnosis was delayed for 1year.

Conclusion:

AFTB is very rare condition. AFTB is suspected in cases with long standing pain/swelling/discharging sinus in the foot and thorough investigations is must to differentiate from other foot diseases. Diagnosis is delayed due to lack of clinical suspicion and non-confirmatory biopsy reports. Early diagnosis and ATT for 9-18 months is must in all cases of AFTB to prevent joint involvement and other complications.

Tuberculosis of the Cuboid: A Case Report and Review of the Literature

Tuberculosis (TB) remains a major global health problem. According to a recent World Health Organization report, it ranks as the second leading cause of death from an infectious disease worldwide. According to the "UK Health Protection Agency Tuberculosis in the UK: 2012 Report," 8963 cases were reported in the United Kingdom in 2011. London had the greatest proportion of cases in the United Kingdom and the greatest rate of disease. TB affecting the foot is rare, affecting about 10% of all skeletal TB cases. However, owing to the current patterns of global immigration, with significant volumes of people migrating out of endemic countries, it has become a disease that physicians and surgeons in developed countries should be more aware of in today's practice. To the best of our knowledge, we present the first adult case of TB of the cuboid in the United Kingdom and the first adult case documented outside of India. We present the case details and the results of a thorough review of the literature. TB of the foot and ankle poses a diagnostic challenge because of the propensity of TB to mimic other pathologic entities radiologically. Tissue diagnosis and antitubercular medication is the mainstay of diagnosis and treatment, respectively.

Long-term follow-up results of foot and ankle tuberculosis in Turkey

The incidence of tuberculosis has been increasing, especially in the past 2 decades. Skeletal tuberculosis is very rare compared with the frequency of the pulmonary form. In the present study, we have shared our long-term experience with foot and ankle tuberculosis, providing information about the different aspects of the disease. A total of 70 patients with foot and ankle tuberculosis, treated from 1983 to 2005, were evaluated. The mean patient age was 34.4 (range 7 to 85) years at the diagnosis. The mean interval between the first symptoms and the diagnosis was 26.4 months (range 1 month to 15 years). The mean follow-up period was 21.7 (range 8 to 30) years. The infection affected both the joint and the bones in 29 patients, only the joints in 13, only the bones in 22, and the soft tissues alone in the remaining 6 patients. The most common joint location was the tibiotalar joint. The talus was the most commonly infiltrated bone. All patients underwent biopsy, and 28 patients underwent additional surgical procedures. In 18 patients (25.7%), 1 to 4 recurrences developed during the follow-up period. In the last follow-up visits, either severe destruction of the bones or end-stage arthrosis was evident in 39 patients (55.7%), especially in those with osseous tuberculosis. Foot and ankle tuberculosis is very rare. The diagnosis of the disease will often be late owing to the lack of pathognomonic findings. A histopathologic evaluation should not be omitted in cases with suspicion. The incidence of residual deformity or end-stage arthrosis has been high in the long term; however, the patients will usually be without any symptoms.

Tuberculosis arthritis of the metatarsal phalangeal: a rare location

Tuberculosis TB is common in countries constituting endemic areas like Morocco, spinal sites represents half of osteo-articular locations, while peripheral locations in the limbs are rare. The authors relate in this observation the case of a particular location of tuberculosis arthritis. It is osteoarthritis of the metatarsophalangeal joint of the 2(nd) ray of the foot. Clinical signs were characterized by a moderately painful swelling of the dorsum of the foot with slow evolution. The definitive diagnosis was histologically obtained. Clinical cure was achieved after 09 months of medical treatment.

Isolated calcaneocuboid joint tuberculosis: a rare case report

Tubercular arthritis affecting the foot is uncommon. Isolated calcaneocuboid joint tuberculosis has never been reported in the literature. Herein we report a case of 43-year-old male who presented with insidious onset pain in hindfoot of 4 months duration. Radiograph revealed destruction of calcaneocuboid joint along with cuboid. Computed Tomography scan further consolidated the findings. Diagnosis was confirmed from aspiration from joint with culture of mycobacterium tuberculosis. Anti-tubercular chemotherapy was started and good clinical response was noted. We reported this case because of its rarity to involve calcaneocuboid joint and the excellent outcome with medical treatment.

Tuberculosis of the calcaneum masquerading as Haglund's deformity: a rare case and brief literature review

An Asian man presented to the Foot and Ankle Clinic with a 5-month history of right ankle pain of gradual onset. He had a non-fluctuant swelling around the Achilles tendon insertion with a tender palpable lump. Radiograph demonstrated Haglund's deformity and also possible calcification at the attachment of the Achilles tendon for which he had an injection of a local anaesthetic and a steroid to treat the insertional Achilles tendinitis. A few months later, he developed acute anorexia, abdominal distension secondary to ascites and groin lymphadenopathy. Histology of the lymph node biopsy revealed granulomatous lymphadenitis consistent with tuberculosis (TB) and started on quadruple agent anti-TB treatment. The sample was not cultured. He developed constant ooze from his groin lymph node biopsy site and also fluctuance around the Achilles tendon and heel. Pus from the heel stained positive for auramine indicating TB calcaneum with subsequent culture for acid fast bacilli (AFB) confirming diagnosis of TB calcaneum.

Unusual locations of osteoarticular tuberculosis in children: a report of 12 cases

INTRODUCTION

Unusual locations of osteoarticular tuberculosis (OA-TB) raise diagnostic issues due to their untypical and non-suggestive clinical and radiological presentation.

OBJECTIVES

The present retrospective study analyzed the various clinical, radiological and therapeutic aspects.

PATIENTS AND METHODS

A retrospective series included 12 children (mean age, 7 years 4 months; sex-ratio, 0.7), treated in our department between 1980 and 2010. Knee, hip and spine locations were excluded.

RESULTS

Mean time to diagnosis was 32 months. Active TB infection was identified in 42% of cases. Pain was the presenting symptom in 83% of cases, with a preponderance of osteitis. Bone loss was the main radiological sign. Phemister's triad was found in two cases of combined articular and bone infection. Diagnosis was confirmed on histology in 92% of cases. All patients were managed according to the Moroccan national TB protocol. Surgery was indicated in five cases, comprising abscess drainage with or without bone surgery (notably for joint dislocation). Four patients showed orthopedic sequelae, including two with associated spinal locations.

DISCUSSION

Rare osteoarticular tuberculosis locations often cause diagnostic problems. Any chronic clinical presentation or suspected atypical bone lesion should suggest a diagnosis of osteoarticular tuberculosis.

LEVEL OF EVIDENCE

Level IV. Retrospective study.

The Appropriate DOTS Regimen Greatly Reduces the Disabilities in Polyarticular EPTB

The placement of cases of Extrapulmonary Tuberculosis (EPTB) on the appropriate Directly Observed Treatment Short Course (DOTS) regimen remains a problematic issue in India and often, consultants delay this, leading to significant avoidable pain, discomfort and reduction in the quality of life of the patients. In contrast, a prompt institution of the DOTS regimen can regress such problems, even at a delayed stage. The following case report on polyarticular tuberculosis which involved the bilateral knee and ankle joints without a pulmonary or disseminated form of tuberculosis, amply highlights these facts.

Long-term retrospective analysis of surgical treatment for irretrievable tuberculosis of the ankle

BACKGROUND

Although antituberculosis medication is the first step in the management of skeletal tuberculosis (TB), surgical debridement, biopsy, synovectomy, or arthrodesis may be needed for the definitive diagnosis and treatment of the symptomatic ankle.

METHODS

Twenty-nine patients with TB around the ankle joint were enrolled during a 23-year period and followed for 73.1 months (range, 30-260 months) after TB was controlled. Among 61 surgical procedures performed in 29 patients, complete resolution of ankle TB was seen in 28 patients.

RESULTS

According to Martini and Ouahes classification, radiographic findings of localized osteoporosis were stage I in 4 patients, one or more erosions were stage II in 9 patients, destruction of the whole joint was stage III in 8 patients, and anatomic disorganization and subluxation were stage IV in 8 patients. Functional results were excellent in 6 patients and good in 16 patients, but with talar bone collapse or hindfoot malalignment, a fair result was noted in 6 patients. The diagnostic accuracy rates were 28.5% with aspiration of synovial fluid, 66.7% in histological analysis, and 44.4% in bacteriological analysis. Mixed infection with bacterial flora was noted in 8 patients (27.6%).

CONCLUSIONS

Ankle TB is easily misdiagnosed and may ultimately involve the peritalar neighboring joints with talar height loss or hindfoot deformity. Successful treatment depends on the extent of disease at presentation, accurate staging, duration of adequate chemotherapy, and optimal surgical intervention.

LEVEL OF EVIDENCE

Level IV, retrospective case series.

Tuberculosis of the right distal fibula bone case repot: An unusual T.B. case

A 26-year-old Asian female was referred to on-call trauma services with 2 weeks history of swelling and pain of her right ankle. On laboratory evaluation, she only had an elevated CRP. Ankle roentgenogram showed a lytic lesion of the distal fibula bone with soft tissue swelling. Chest roentgenogram was abnormal along with clinical findings. Bacteriological report from right ankle specimen isolated Acid Fast Bacilli. Histological examination of the biopsy tissue showed granuloma and caseating necrosis of tuberculosis. She had incision and radical debridement of abscess and received anti-tuberculous therapy. During her follow-up in clinic, no residual or recurrent disease was established.

Tuberculosis of the foot: An osteolytic variety

BACKGROUND

Foot involvement in osteoarticular tuberculosis is uncommon and isolated bony involvement of foot bones with an osteolytic defect is even more rare; diagnostic and therapeutic delays can occur, worsening the prognosis. We present a retrospective series of osteolytic variety of foot tuberculosis.

MATERIALS AND METHODS

We present 24 osteolytic variety of foot tuberculosis (Eleven calcaneus, four cuboid, two cunieforms, one talus, three metatarsals, three phalanges) out of 92 foot TB cases collected over last 20 years. There were 16 adults and eight children. Tissue diagnosis was established in 23 of 24 cases based on PCR AFB staining, culture, and histopathology. Surgical intervention was reserved for patients with either a juxtaarticular focus threatening to involve a joint or an impending collapse of a midfoot bone with cystic destruction.

RESULTS

Fifteen cases had an osteolytic lesion on the radiographs resembling a space-occupying lesion, five had patchy osteolysis, while four showed coke like sequestra; one patient had a lesion in two bones. Antitubercular chemotherapy after biopsy was sufficient to heal the lesion in 19 cases, while in five cases surgical debridement needed to be done. The lesions healed eventually. At an average followup of 8.3 years, (range 2-15 years) there were no recurrences and all patients were free from pain, with no restriction of movements. Six patients complained of occasional pain during walking on uneven ground.

CONCLUSION

When tuberculous pathology is limited to the bone, the prognosis is better than in articular disease, as there is less deformity, and hence, less residual pain and disability.

Tubercular osteomyelitis of the second metatarsal: a case report

A number of studies have described the osteoarticular involvement of tuberculosis, but very few cases of tubercular osteomyelitis of the foot have been reported. We describe a case of spina ventosa affecting the second metatarsal, with a review of the literature and description of the clinical manifestations, diagnostic images, and treatment of skeletal tuberculosis.

Tuberculosis of the foot and ankle in children

PURPOSE

To report manifestations and management of tuberculosis of the foot and ankle in 21 children.

METHODS

Records of 12 girls and 9 boys aged 3 to 14 (mean, 7) years with tuberculosis of the foot and ankle were reviewed. The mean delay in presentation was 4.7 (range, 0.5-14) months. All the patients had local swelling, tenderness, and antalgic gait; 16 were limping; 5 had an antecedent trauma; 11 had an abscess; and 6 had a discharging sinus. The diagnosis was based on a smear positive for acid-fast bacilli (n=2), histopathology (n=15), or clinicoradiological findings (n=4). Nine patients had osteoarticular tuberculosis in other parts of the body. None had evidence of pulmonary tuberculosis. Lesions were classified into synovial (articular) and osseous. All 3 synovial lesions occurred in the ankle, 2 of which were at an advanced stage. Osseous lesions occurred in the calcaneus (n=5), metatarsal (n=5), talus (n=3), cuboid (n=3), medial cuneiform (n=1), and phalanx (n=1), and were sub-classified into stages 1 (n=3), 2 (n=5), and 3 (n=10) according to disease progression. All the patients were treated conservatively with splintage and chemotherapy.

RESULTS

The mean follow-up period was 21 (range, 7-51) months. All the 3 patients with stage 1 osseous lesions showed healing within 6 weeks and had complete recovery of function. Four of the 5 patients with stage 2 lesions also showed complete recovery of function and reformation of bony trabeculations; radiological incorporation of sequestrum was obvious by 6 months in most patients. In patients with stage 3 lesions, healing was delayed and there was residual alteration in bony architecture and joint changes. Sclerotic changes and joint involvement also increased the likelihood of poor outcomes. However, none of our patients had any residual tenderness or foot deformity at the final follow-up.

CONCLUSION

Outcome after non-operative treatment is good, provided the lesions are treated early.

Tuberculosis of and around the ankle

Osteoarticular tuberculosis of the ankle joint is rare, and diagnostic delays are common with this condition. The aim of our report is to highlight the varied clinical and radiologic presentation of this entity. We present a retrospective review of 16 patients with tuberculosis in and around the ankle joint who were surgically treated during a 6-year period. The incidence of ankle joint involvement in extraspinal osteoarticular tuberculosis was 15.7% in our unit. The most common presentation in our series was chronic septic arthritis, followed by periarticular osseous lytic lesion. Tuberculous synovitis, tenosynovits, and retrocalcaneal bursitis were also seen. Osteopenia, the hallmark of osteoarticular tuberculosis, might not be seen in all forms of tuberculosis affecting this joint. Chemotherapy remains the mainstay of treatment. Adjuvant surgery is often required to establish the diagnosis and in the treatment of patients with deformity and widespread destruction of articular cartilage owing to delayed presentation.

Transmalleolar approach to a tubercular lytic lesion of the talar body: a case report

Tuberculosis of the talus is a rare condition, and the diagnosis can be difficult to make because of inconclusive laboratory and ancillary testing. In such cases, accurate diagnosis and appropriate treatment may require the use of a transmalleolar osteotomy to gain access to the involved portion of the talar body. In the case described in this article, a transmalleolar approach was used to gain access to a lytic lesion of the talar body so as to obtain microbiological and histopathological specimens for diagnostic purposes, and to thoroughly debride the lesion. After 6 years of postsurgical follow-up, the patient was leading a normal life with a full range of ankle and subtalar motion. The rarity of the diagnosis, and the use of the transmalleolar approach to a lytic and likely infected lesion in the body of the talus, makes this case worthy of public discussion.

Isolated tubercular pseudotumour of lateral malleolus

A 22-year-young adult presented with a painless swelling of distal fibula on right side for 3-month duration. He had no constitutional symptoms and there was full range of painfree ankle movement. Radiographs showed cortical breech with an osteolytic lesion in lateral malleolus. Magnetic Resonance Imaging showed T2W hyperintense signal in the distal fibula. It further revealed involvement of tendo Achilles and paroneal tendons. Fine needle aspiration cytology showed epitheloid granuloma and Langhans giant cells. The Mycobacterium tuberculosis DNA could be identified on polymerase chain reaction. The patient received 18 months of antitubercular treatment and the lesion subsided. There is no recurrence even after 3 years of follow up. A strong suspicion of tuberculosis should be considered in any bony swelling of a patient from endemic area, even at atypical sites. Polymerase chain reaction analysis should be performed in addition to radiological and histological examination of the lesion to establish the diagnosis. Early treatment with antitubercular therapy decreases the morbidity and avoids the possibility of surgical intervention.

Foot ulcer caused by multidrug-resistant Mycobacterium tuberculosis in a diabetic patient

Osteoarticular tuberculosis is the fourth leading type of extrapulmonary tuberculosis. The disease has a progressive course and the diagnosis is often made in the later stages of bone destruction. We describe a case of a foot ulcer caused by drug-resistant Mycobacterium tuberculosis in a patient with known diabetes where the diagnosis was not suspected initially. Although tuberculous foot ulcers are rare, they should be included in the differential diagnosis of unknown foot ulcers. A greater awareness of this rare clinical entity may help in commencing specific evidence-based therapy quickly and preventing undue morbidity and mortality.

Tibiotalocalcaneal arthrodesis using a supracondylar femoral nail for advanced tuberculous arthritis of the ankle

PURPOSE

To review 7 patients with advanced osteoarticular tuberculous arthritis of the ankle who underwent arthrodesis using a supracondylar femoral nail.

METHODS

All patients showed gross destruction of the articular cartilage of the tibiotalar joint with severe periarticular rarefaction on radiographs. Their pre- and one-year post-operative Foot and Ankle Outcome Scores (FAOS) were compared. All patients underwent joint debridement, complete synovial excision, and arthrodesis using a supracondylar femoral nail, followed by multidrug chemotherapy for 12 months (isoniazid, rifampicin, pyrazinamide, and ethambutol for 3 months, and isoniazid and rifampicin for 9 months).

RESULTS

All patients achieved fusion in a mean of 13 weeks and regained their preoperative level of independence. No patient had a relapse, major complications, or hardware failure. At postoperative year one, the mean FAOS for pain improved to 85 from 26, whereas the mean FAOS for quality of life improved to 60 from 5.

CONCLUSION

Tibiotalocalcaneal arthrodesis using a supracondylar femoral nail, combined with debridement and multidrug therapy, enabled a reliable one-stage solution for advanced osteoarticular tuberculosis and early return to function.

Tuberculous osteomyelitis of the midfoot: a case report

INTRODUCTION

The prevalence of tuberculosis is increasing and musculoskeletal tuberculosis, although currently rare, may become an important problem.

CASE PRESENTATION

We report the case of a 20-year-old Somalian man, who presented with an inversion injury to his ankle. When further history was taken, it transpired that he had sustained trauma to his ankle in Somalia 4 years previously, complicated by a non-healing wound. His foot pain and swelling had been present ever since. Diagnosis of tuberculosis was made by bone biopsy, histology of which demonstrated caseating granulomas. Tissue culture yielded growth of tuberculous bacilli. The patient made a full recovery on anti-tuberculous treatment.

CONCLUSION

Musculoskeletal tuberculosis can be difficult to diagnose as only about one third of patients have respiratory symptoms. Synovial fluid aspirate is relatively unlikely to lead to definitive diagnosis, and a bone biopsy should always be taken for culture and histological examination.

Diagnostic dilemma of tuberculosis in the foot and ankle

BACKGROUND

Isolated involvement of bone in tuberculous infection is uncommon, and the variable clinical and radiological features may mimic pyogenic osteomyelitis, bone tumor or other inflammatory and neoplastic processes of the synovium. We have reported our experiences with the diagnosis of tuberculosis infection in the ankle and foot with the hope of providing sufficient information about these cases to lead to early diagnosis.

MATERIALS AND METHODS

We treated 15 patients with tuberculosis involving the foot and ankle between 1995 and 2005. They were followed for a minimum of 24 months, and the average duration of symptoms was 23 months. All patients underwent a physical examination, routine laboratory tests, plain radiographs, and a biopsy of the infection site. MRI studies were performed in 10 patients and a CT scan was done in one patient.

RESULTS

The lesions were located in the forefoot (2), midfoot (3) and ankle (10). From the imaging studies, the presumptive preoperative diagnoses were tuberculous osteomyelitis (7), pyogenic osteomyelitis (4), pigmented villonodular synovitis (2), amyloidosis (1), and avascular necrosis of the talus (1). These diagnoses were verified by granulomatous inflammation with or without caseous necrosis on histology and tubercle bacilli were cultured in four cases. In three cases the diagnosis was made by polymerase chain reaction (PCR).

CONCLUSION

When a patient presents with a localized, painful swelling and a persistent draining sinus of the foot and ankle, tuberculosis should be considered in the differential diagnosis. Additionally, we highly recommend taking a biopsy of the site of suspected infection because an early diagnosis is the key to successful treatment.

[Tarsal osteoarthritis: a rare localisation of tuberculosis]

We report the case of a 39-year-old woman with an uneventful medical history who presented an inflammatory left foot with no notion of trauma or fever. The plain x-ray and magnetic resonance imaging demonstrated talonavicular and subtalar osteoarthritis. A surgical biopsy with excision of inflammatory and necrotic tissue and removal of a fistular tract was performed. Histology revealed the presence of granulomas with caseous central necrosis suggesting tuberculosis of the bone. The diagnosis was confirmed when bacteriology samples grew Mycobacterium tuberculosis. Antituberculosis drugs were administered for twelve months. At 24 months, the patient presents a painful stiff rear foot after the development of secondary talonavicular degeneration. This case illustrates a particular clinical presentation of tuberculosis. This diagnosis should be considered in the presence of atypical bony lesions with a chronic course. Early diagnosis enables proper therapeutic management. Useful diagnostic imaging techniques include plain x-rays, computed tomography, and magnetic resonance imaging. Certain diagnosis is based on bacteriological and histological examinations.

Arthroscopically assisted ankle fusion in patients with end-stage tuberculosis

PURPOSE

Our purpose was to evaluate the clinical outcomes of arthroscopically assisted ankle fusion in patients with end-stage tuberculosis.

METHODS

Ten patients, all with end-stage tuberculosis, were operated on by arthroscopically assisted ankle fusion, and a half-ring sulcated external fixator was used. Partial weight-bearing was started on the fourth day. The clinical results were assessed with the American Orthopaedic Foot & Ankle Society score. Ankle fusion was proved by radiographs.

RESULTS

At the mean follow-up of 23 months, all fusions were healed; the mean time to radiologic healing was 14.5 weeks. The final American Orthopaedic Foot & Ankle Society score was 66 points.

CONCLUSIONS

Arthroscopically assisted debridement and ankle arthrodesis with an external fixator provided a very satisfactory rate of ankle fusion in 10 patients who had no recurrences or other complications.

LEVEL OF EVIDENCE

Level IV, therapeutic case series.

Mycobacterium tuberculosis infection of a presumed Charcot joint

A 65-year-old male with peripheral neuropathy and small lymphocytic lymphoma presented with erythema and edema of the left foot. A Charcot midfoot was diagnosed and treated with a total contact cast and restricted weight bearing. However, subsequent analysis of bone and synovial fluid months later revealed Mycobacterium tuberculosis infection.

Calcaneal tumors and tumor-like conditions

Approximately 3% of osseous tumors occur in the foot and ankle. Solitary bone cysts, chondroblastoma, intraosseous lipoma, osteoid osteoma, chondrosarcoma, and Ewing's sarcoma seem to have a predilection for the calcaneus. Biopsy is often a crucial step in management. Tumor-like conditions, such as cysts, reactive lesions, and osteomyelitis, must be considered during evaluation. Treatment is often observation or curettage of benign lesions and resection or amputation for malignancies.

Ankle tuberculosis: a report of four cases in a Japanese hospital

We report four patients suffering from ankle tuberculosis, which is an uncommon disease in Japan. All patients complained of swelling and pain in the affected ankle. Ankle tuberculosis is a disorder that can be easily misdiagnosed. The mean delay in diagnosis was 5.3 months in our series. All patients had already been diagnosed as having ankle tuberculosis by the time they visited our hospital in this series. The patients had been definitively diagnosed to have ankle tuberculosis by means of a needle biopsy in two cases, an open biopsy in one case, and on the basis of the clinical features in one case. All patients received antitubercular therapy and non-weight-bearing protective treatment. Antitubercular therapy was performed for an average of 14.3 months, and non-weight-bearing treatment was maintained for a mean of 4.5 months. The main treatments for such cases include open biopsy for an uncertain diagnosis, débridement for intractable synovitis, and arthrodesis for severely destroyed ankles with pain. All patients received some form of surgical intervention either from previous doctors or from us in this series. We conclude that most patients who suffer from ankle tuberculosis seem to need surgery in addition to adequate chemotherapy and non-weight-bearing protective treatment.