Tuberculosis around the tarsal navicular: A rare entity
Introduction
Tuberculosis (TB) has no more remained an endemic disease having been labeled a “Global Emergency” by WHO [1]. This declaration is due to the occurrence of illness in the developed world due to population immigration and an aging population. Also, the human immunodeficiency virus (HIV) pandemic has added to the resurgence of tuberculosis [2]. Even though the number of cases of pulmonary tuberculosis has remained constant (and has even declined in the developed world), the number of extra-pulmonary tuberculosis (EPTB) patients has consistently risen. This increase in the number of EPTB patients led to the involvement of unusual sites more frequently. An early diagnosis and adequate medical management play a critical role in achieving a fair to a good outcome. The knowledge of rare sites of infections and unusual presentations, thus, makes the clinician more adept at picking the subtle early signs of tuberculosis.
Osteoarticular TB affecting the foot is uncommon. The incidence of osteoarticular TB is less than 3% of EPTB cases, with foot and ankle comprising <1% of all instances of osteoarticular TB [3], [4]. The symptoms in the foot are non-specific, and hematological investigations are often inconclusive, making the diagnosis difficult.
Tuberculosis around the tarsal navicular is a highly rare entity, and very few cases have been reported in the literature as case reports [5]. A case series of three patients, two with TB of the talonavicular and one patient with TB of naviculo-cuneiform joint, along with a brief discussion of the possible differential diagnoses and the course of management is presented.
Section snippets
Case 1
A 25-year-old lady presented with pain and swelling in the midfoot, which was insidious in onset and gradually increased over a period of four months. The anteroposterior and lateral radiographs of the foot were done. These showed a reduction of the talonavicular joint space (Fig. 1). The ESR was high (54 mm in the first hour). MRI of the foot was done which revealed a reduction in the talonavicular joint space and presence of edema in the peri-articular area which was hyperintense on T1 and
Discussion
The osteoarticular involvement of tuberculosis is uncommon [6]. The participation of different sites in the foot (like talonavicular and naviculocuneiform joints) and nonspecific clinical symptoms further complicates the situation. The delay in diagnosis, due to lack of awareness causes worsening in the prognosis of the disease and significant morbidity to the patient.
The involvement of the foot, especially in the midfoot, is routinely widespread at presentation because of multiple lymphatic
Funding
No funding has been received for the present study.
References (16)
- et al.
Paradox of the global emergency of tuberculosis
Lancet
(1999) - et al.
Tuberculosis infection of the talo navicular joint
Foot
(2010) - et al.
Skeletal tuberculosis. A review with patient presentations and discussion
Am J Med
(1970) - et al.
Isolated C joint tuberculosis—a diagnostic dilemma
Foot
(2015) The talonavicular and calcaneocuboid joints: anatomy, biomechanics, and clinical management of the transverse tarsal joint
Foot Ankle Clin
(2004)- et al.
Isolated medial cuneiform tuberculosis: a case report
J Foot Ankle Surg
(2005) - et al.
The global emergency of tuberculosis: what is the cause?
J R Soc Promot Health
(2002) - et al.
Tuberculous osteomyelitis of the cuboid: a report of four cases
J Foot Ankle Surg
(2002)