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 lateral condylar fractures of the humerus are the second most common injury around the elbow in children. Treatment of patients presenting late is controversial. We report our experience of treatment of these fracture over last thirteen years in 78 children seen between 1987 and 2000. Average age- 5.2 years ; 53 patients presented early and 25 patients presented more than 3 weeks after injury . In latter, 11 patients were treated conservatively and rest by internal fixation. Pseudovarus was observed in 30% cases on long term followup. Of 25 patients presenting late, open reduction, internal fixation with bone grafting was carried out in eight cases (those who presented between 3–6 weeks) and rest of the 17 cases were kept under observation on regular follow up. At final follow up, the cases operated late (n= 8) had preservation of 70–80 % of Flexion Extension Arc. Of the 17 cases kept under observation, 8 (showing non union) developed cubitus valgus. 9 cases (showing malunion) continue to have stiff elbow . The elbow function was better in the former group. We suggest that every effort should be made to fix the lateral condylar fragment in patients presenting even more than 3 weeks especially if the metaphyseal chunk is large, the fragment is not widely displaced and rotated and the fracture is type II Milch in a very young child (as those patients rapidly develop very severe cubitus valgus deformity with translocation of ulna).