TUBERCULOSIS OF THE FOOT AND ANKLE IN CHILDREN

Abstract

After tuberculosis of the spine, hip and knee, tuberculosis of the foot and ankle is the most common occurring area of skeletal tuberculosis seen in our unit. We retrospectively reviewed 14 patients (14 feet and/or ankles) seen over the 16-year period 1982 to 1997.

The average age of the children was 5.2 years (range 1.5 to 11 years). The duration of symptoms ranged from 1 week to 1 year. The most common presentation was swelling and pain of the involved joint, but three patients each presented with a chronic discharging sinus after being drained elsewhere as an acute abscess. Radiographs revealed osteo-penia with or without lytic areas, joint margin destruction or joint space narrowing. The average sedimentation rate (ESR) was 52.3 mm/hour (range 9 to 120). The Mantoux test was positive in 13 out of the 14 patients. Chest x-rays demonstrated latent or active tuberculosis in 50% of patients. Open biopsy was performed in all patients. Hypertrophic synovium was found in all cases except one, where atrophic tuberculosis with joint space narrowing was present. A positive diagnosis of tuberculosis was made in all cases, either by demonstrating caseating granulomatous tissue on histology, or by growing a positive culture for mycobacterium tuberculosis or both. Histology was positive in 86%, acid-fast bacteria were seen in 28.5% and a positive culture was obtained in 82% of the patients.

At an average follow up of 7.4 years (range 1 to 17 years) all patients were assessed both clinically and radiologically. Patients with lytic lesions and destruction of joint margins reconstituted well radiologically, had a good clinical outcome with a good range of movement of the affected joint, however the one patient with atrophic tuberculosis remained with a narrowed joint space, stiffness and a poor clinical result compared to the rest.