Tuberculosis of the foot: An osteolytic variety

Abstract

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.

Tuberculosis of calcaneum: a case series and review of literature

“…Residual cavities may get filled up with fibrous or fibroosseous tissue and have no clinical significance. 3,5,14,15 Calcaneal TB can be mimicked by bacterial infections, histocytosis, metastatic disease, symptomatic Haglund's deformity etc. 11,16 Therefore investigations, laboratory based as well as imaging play an important role in diagnosis.…”

“…This coupled with a lack of awareness on the part of the surgeon often delays the diagnosis and can hence lead to an unsatisfactory clinical outcome and residual functional disability. 3 Even after a thorough literature search we could find only a handful of case reports and only two case series describing this rare clinical condition.…”

Tuberculosis of ankle – a case report

“…In our case tubercular drugs were advised for 9 months as recurrence is higher after shorter course. [6,7] As, results of conservative treatment are very good hence surgical intervention (debridement and curettage, excision of sequestrated/destroyed bones and arthrodesis) is reserved only for failure of conservative therapy. In our case arthrotomy and biopsy for histopathological examination and TB PCR was done as diagnostic and therapeutic mode of management.…”

Tuberculosis: a rare cause of foot and ankle pain

“…It commonly occurs in lungs but can occasionally infect any part of the body. Bones and joints are involved in 1-3% of all tuberculosis cases and in 15% of extra-pulmonary tuberculosis cases [1]. According to dispersion and frequency range, bone and joints tuberculosis mainly infects the vertebra (50%), whereas occurrences in hips, knees, foot-ankle area (10%) are seldom observed [2][3][4].…”