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Published on: January 23, 2018
Insight into tuberculosis of talus in children: A review of five cases
Anil Agarwal1, Sitanshu Barik2, Lokesh Sharma1
1Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, 110031, India.
Insights
Pediatric tuberculosis of the talus is rare but treatable. Early diagnosis and anti-tubercular therapy lead to favorable outcomes, even with osseous lesions.
Area of Science:
- Orthopedic surgery
- Pediatric infectious diseases
- Radiology
Background:
- Tubercular affection of the talus in children is exceptionally rare, with limited case reports available.
- This study investigates five pediatric cases of tuberculosis affecting the talus, detailing presentations and treatment outcomes.
- Methods involved reviewing demographic data, clinical presentation, diagnosis, treatment, and follow-up outcomes for five children with biopsy-proven talar tuberculosis.
Observation:
- The majority of cases (4/5) involved osseous lesions, primarily located in the head and/or head-neck junction of the talus.
- Symptom duration ranged from three to 12 months.
- Two cases exhibited residual small, geographic lytic lesions, potentially representing healed cystic cavities.
Findings:
- Standard anti-tubercular therapy resulted in uneventful healing in three out of five cases, with normal radiographs at follow-up.
- Diagnosis of talar tuberculosis in children presents challenges, necessitating a high index of suspicion for persistent ankle/hindfoot pain.
- Talar tuberculosis can manifest as osseous or synovial involvement, with lesions in the head and neck requiring specific investigation.
Implications:
- Prompt diagnosis and treatment with anti-tubercular drugs are effective for both clinical and radiological healing of talar tuberculosis.
- Lesions in non-weight-bearing areas of the talus help maintain bone shape and prevent collapse.
- Increased awareness and investigation of talar tuberculosis are crucial for pediatric orthopedic and infectious disease specialists.
Background:
Tubercular affection of talus in children is considered extremely rare with literature limited to few case reports. This study reports five cases of tubercular infection of talus in children and traces the various presentations and the treatment outcome. MethodsThe series describes five children with biopsy proven affection of tuberculosis of talus. Data reviewed included the demographic data, clinical presentation, diagnosis, treatment and outcome at final follow up.
Results:
Among the five cases described in this series, the majority were osseous (4/5). The location of the osseous lesions was noted in the head as well as the head-neck junction of the talus. The duration of symptoms varied from three to 12 months. Three of the five cases healed uneventfully after the initiation of standard anti-tubercular therapy with normal appearing radiographs at the latest follow up. Two cases still had small, geographic lytic lesions in the talus. These might represent healed cystic cavities filled with fibrous.
Conclusion:
The diagnosis of tuberculosis of talus in children is challenging. A high index of suspicion is required for patients presenting pain around the ankle and hindfoot for more than four weeks. The involvement of the talar bone in tuberculosis can be osseous or synovial. Lesions in the head and neck should particularly be investigated for tubercular etiology. Once diagnosed, antitubercular drugs are effective in healing the lesions clinically as well as radiologically. The presence of lesions in the non-weight bearing area of the talus prevents bony collapse and eventual shape is maintained.
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