Diagnostic dilemma of tuberculosis in the foot and ankle

Jin Choi Woo, Hwan Han Seung, Hwan Joo Jong, Soo Kim Bom, Woo Lee Jin

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)711-715
Number of pages5
JournalFoot and Ankle International
Volume29
Issue number7
DOIs
Publication statusPublished - 2008 Jul 1

Fingerprint

Ankle
Foot
Tuberculosis
Osteomyelitis
Infection
Early Diagnosis
Necrosis
Pigmented Villonodular Synovitis
Neoplastic Processes
Biopsy
Bone and Bones
Talus
Synovial Membrane
Amyloidosis
Bacillus
Physical Examination
Histology
Differential Diagnosis
Inflammation
Polymerase Chain Reaction

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Woo, Jin Choi ; Seung, Hwan Han ; Jong, Hwan Joo ; Bom, Soo Kim ; Jin, Woo Lee. / Diagnostic dilemma of tuberculosis in the foot and ankle. In: Foot and Ankle International. 2008 ; Vol. 29, No. 7. pp. 711-715.
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Diagnostic dilemma of tuberculosis in the foot and ankle. / Woo, Jin Choi; Seung, Hwan Han; Jong, Hwan Joo; Bom, Soo Kim; Jin, Woo Lee.

In: Foot and Ankle International, Vol. 29, No. 7, 01.07.2008, p. 711-715.

Research output: Contribution to journalArticle

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