Ankle and foot tuberculosis: A diagnostic dilemma

Abstract

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.

Tuberculous Osteomyelitis of the First Metatarsophalangeal Joint Misdiagnosed as Gouty Arthritis

“…In foot, the lesion involves calcaneum, talus, first metatarsal and navicular bones in order of decreasing frequency. Pulmonary involvement is uncommon and present in less than 50% of cases [7]. In our case pleural thickening was observed, we tried ultrasound guided thoracentesis twice, but it failed because of scanty pleural fluid.…”

Tubercular involvement of the lateral malleolus and adjacent calcaneus: presentation of a rare case and review of the literature

“…On evaluating the literature, the number of reported cases involving the calcaneus was 88 out of 312 cases of foot TB (table 2). 2 7–23 The high incidence of calcaneal involvement could probably be due to the fact that it is the biggest and most vascular bone of the foot, and is subjected to the maximum strains of the primary contact to the ground.…”

“…The current protocol of treatment of osteoarticular TB has been a prolonged duration of 9–18 months 18 30. Prolonged treatment in osteoarticular TB is justified by the fact that it is a paucibacillary infection with many organisms being in a dormant state, making them resistant to chemotherapy 13.…”

A case of painful ankle swelling: Cytomorphological clues and pitfalls

“…[ 10 ] Peripheral marginal erosion of joint is the earliest change in plain radiography. [ 3 ] Coke-like sequestrum is often noted. [ 10 ] Magnetic resonance imaging (MRI) of the foot shows early joint effusions and soft tissue swelling.…”

“…[ 4 ] The radiological features of tuberculosis of ankle and foot may be similar to that of rheumatoid arthritis, sarcoidosis, neuropathic joints, and neoplasms. [ 3 ]…”