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Ankle and foot tuberculosis: a diagnostic dilemma
Biswaranjan Nayak1, Rashmi Rani Dash2, Kailash Chandra Mohapatra1
1Department of General Surgery, S.C.B. Medical College, Cuttack, Orissa, India.
Journal of Family Medicine and Primary Care
|August 28, 2014
Summary
Ankle and foot tuberculosis (AFTB) is rare, often delayed in diagnosis due to low suspicion and inconclusive biopsies. Early detection and treatment are crucial for preventing complications.
Area of Science:
- Orthopedics
- Infectious Diseases
- Radiology
Background:
- Tuberculosis can affect the ankle and foot, presenting as non-healing ulcers, sinuses, or swellings.
- Delayed diagnosis of ankle and foot tuberculosis (AFTB) can lead to significant morbidity and complications.
Purpose of the Study:
- To elucidate the clinical behavior of ankle and foot tuberculosis (AFTB).
- To identify the reasons for diagnostic and treatment delays in AFTB cases within the studied population.
Main Methods:
- Retrospective analysis of 20 AFTB cases treated between July 2007 and June 2012.
- Inclusion criteria: patients with non-healing ulcers, sinuses, or swellings in the ankle and foot.
- Diagnostic methods included clinical history, physical examination, Acid Fast Bacilli (AFB) studies on discharge, and wound margin/sinus tract biopsies.
Main Results:
- Five out of 20 cases experienced diagnostic delays, ranging from 6 months to 5 years.
- Difficult-to-diagnose cases included three diabetic patients with ulcers/sinuses and one misdiagnosed as angiodysplasia.
- One case of rheumatoid arthritis with an ankle abscess had a 1-year diagnostic delay.
Conclusions:
- Ankle and foot tuberculosis (AFTB) is an uncommon condition requiring high clinical suspicion for early diagnosis.
- Diagnostic delays are attributed to a lack of suspicion and non-confirmatory biopsy results.
- Prompt diagnosis and appropriate anti-tuberculosis therapy (ATT) for 9-18 months are essential to prevent joint involvement and other sequelae.
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