Abstract
The diagnosis of painful heel syndrome is quite common in any busy orthopaedics OPD. Though neoplasm and infections are not uncommon in calcaneum, the surgeon does not suspect infection unless there is an obvious history of punctured wound or constitutional symptoms. As such till date there is no series of large number of cases of calcaneal tuberculosis. We present our experience with 39 cases of calcaneal tuberculosis which include 2 cases of simultaneous bilateral symmetric involvement and 13 cases of tubercular lesion at the site of the attachment of Tendoachilles and Plantar Fascia. A classification of calcaneal tuberculosis is proposed.
Material & Methods: (n=39) age 6–60 years; male: female – 20:19; duration of symptoms – 2 weeks to 8 years; “Heel up” sign present in 19 cases; X-ray showed erosive lesion at the site of Tendoachilles attachment (enthesitic type lesion) – 8 cases; erosive lesion at the site of Plantar Fascia attachment – 5 cases; Intraosseous lytic lesion(s) without subtalar joint involvment – 23 cases; subtalar joint involvemnet – 3 cases. FNAC was positive in 17 cases and core biopsy revealed tubercular material in 12 cases. All cases except one were treated conservatively.
Discussion: The diagnosis and treatment of calcaneal tuberculosis are often delayed because the surgeon is unaware and signs and symptoms of calcaneal osteomyelitis are less dramatic than seen in osteomyelitis of long bones. The diagnostic and radiological features will be discussed.
The abstracts were prepared by Professor Jegan Krishnan. Correspondence should be addressed to him at the Flinders Medical Centre, Bedford Park 5047, Australia.
