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Unveiling foot tuberculosis as an under-recognized source of foot pain

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Abstract

Purpose

Foot tuberculosis is a rare form of osteoarticular tuberculosis, accounting for less than 1% of cases. It presents unique diagnostic challenges due to its nonspecific clinical features and overlapping symptoms with other conditions. This study aimed to investigate the clinical presentation, radiographic findings, and prognosis of foot tuberculosis, with the goal of improving early recognition and appropriate intervention.

Methods

A prospective study was conducted between November 2016 and July 2021, involving 39 patients diagnosed with foot tuberculosis. Clinical examinations, laboratory tests, X-rays, and MRI evaluations were performed to aid in the diagnosis. Biopsy was conducted on patients with radiological lesions. Patients were treated with an 18-month course of antitubercular therapy (ATT). Foot Function Index (FFI) scores were recorded before and after treatment. Statistical analysis was conducted to assess factors impacting prognosis.

Results

Unilateral foot involvement was observed in all patients, with a male predominance (61.5%) and a mean age of 31.3 years. The most common symptoms were pain and edema, with sinus tracts present in 17.9% of patients. Radiographic findings showed cystic and sclerotic lesions, with the "spina ventosa" appearance primarily affecting the metatarsal bones. MRI played a valuable role in early detection. Histopathological examination confirmed tuberculosis in all cases, and acid-fast bacilli were found in 23% of patients. Most patients (79.4%) responded well to ATT without requiring surgery. Factors such as high initial ESR, delayed ATT initiation, multiple lesions, and tarsal involvement were associated with unfavourable outcomes.

Conclusion

Foot tuberculosis presents with nonspecific symptoms, leading to misdiagnosis and delays in appropriate treatment. Clinical examination, radiographic evaluation, and biopsy are essential for accurate diagnosis. Early initiation of ATT is crucial for favourable outcomes. Factors such as high initial ESR, delayed treatment initiation, multiple lesions, and tarsal involvement negatively impact prognosis. This study highlights the importance of recognizing foot tuberculosis and provides insights into its clinical presentation, radiographic features, and treatment outcomes, facilitating timely intervention and improved patient management.

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References

  1. Mathers C, Stevens GA, Hogan DR, Mahanani WR, Ho JY (2017) Global and regional causes of death: Patterns and trends, 2000–15. In The World Bank eBooks (pp. 69–104). https://doi.org/10.1596/978-1-4648-0527-1_ch4

  2. Tuli S (2016) Tuberculosis of the Skeletal System. JP Medical Ltd

    Google Scholar 

  3. Prakash J, Mehtani A (2017) Hand and wrist tuberculosis in paediatric patients – our experience in 44 patients. J Pediatr Orthop B 26(3):250–260. https://doi.org/10.1097/bpb.0000000000000325

    Article  PubMed  Google Scholar 

  4. Prakash J (2014) Tuberculosis of capitate bone in a skeletally immature patient: A case report. Malays Orthop J. https://doi.org/10.5704/moj.1403.005

    Article  PubMed  PubMed Central  Google Scholar 

  5. Davidson PT, Horowitz I (1970) Skeletal tuberculosis. Am J Med 48(1):77–84. https://doi.org/10.1016/0002-9343(70)90101-4

    Article  CAS  PubMed  Google Scholar 

  6. Aisenberg GM, Jacobson K, Chemaly RF, Rolston KVI, Raad I, Safdar A (2005) Extrapulmonary tuberculosis active infection misdiagnosed as cancer. Cancer 104(12):2882–2887. https://doi.org/10.1002/cncr.21541

    Article  PubMed  Google Scholar 

  7. Choi WJ, Han SH, Joo JK, Kim BS, Lee JY (2008) Diagnostic dilemma of tuberculosis in the foot and ankle. Foot Ankle Int 29(7):711–715. https://doi.org/10.3113/fai.2008.0711

    Article  PubMed  Google Scholar 

  8. Prakash J, Agnihotri A, Jaiswal Y, Mehtani A (2014) A very rare cause of chronic foot pain in a child: metatarsal tubercular osteomyelitis. Case Rep. https://doi.org/10.1136/bcr-2014-205343

    Article  Google Scholar 

  9. Dhillon MS, Nagi ON (2002) Tuberculosis of the Foot and Ankle. Clin Orthop Relat Res 398:107–113. https://doi.org/10.1097/00003086-200205000-00015

    Article  Google Scholar 

  10. Rainey-McDonald CG et al (1983) Validity of a two-variable nutritional index for use in electing candidates for nutritional support. J Parenter Enter Nutr 7:15

    Article  Google Scholar 

  11. Prakash J, Sareen A, Arora P, Chopra R (2019) Sternoclavicular tuberculosis: an atypical imitator of refractory shoulder pain. Int Orthop 44(4):693–698. https://doi.org/10.1007/s00264-019-04400-3

    Article  PubMed  Google Scholar 

  12. Budiman-Mak E, Conrad KJ, Roach KE (1991) The foot function index: A measure of foot pain and disability. J Clin Epidemiol 44(6):561–570. https://doi.org/10.1016/0895-4356(91)90220-4

    Article  CAS  PubMed  Google Scholar 

  13. Prakash J (2014) Sacroiliac tuberculosis – A neglected differential in refractory low back pain – Our series of 35 patients. J Clin Orthop Trauma 5(3):146–153. https://doi.org/10.1016/j.jcot.2014.07.008

    Article  PubMed  PubMed Central  Google Scholar 

  14. Dhillon MS, Singh P, Sharma R, Gill SS, Nagi ON (2000) Tuberculous osteomyelitis of the cuboid: A report of four cases. J Foot Ankle Surg 39(5):329–335. https://doi.org/10.1016/s1067-2516(00)80049-6

    Article  CAS  PubMed  Google Scholar 

  15. Garcia-Porrua C, González-Gay MA, Sanchez-Andrade A, Vázquez-Caruncho M (1998) Arthritis in the right great toe as the clinical presentation of tuberculosis. Arthritis Rheum 41(2):374–375. https://doi.org/10.1002/1529-0131(199802)41:2

    Article  CAS  PubMed  Google Scholar 

  16. Gupta R, Dhillon MS, Bahadur R, Nagi ON (2000) Multi- focal involvement of the foot in tuberculosis. Ind J Foot Surg XV:55–59

    Google Scholar 

  17. Murphy MC, Murphy AN, Hughes H, McEneaney OJ, O’Keane C, Kavanagh E (2020) Multimodal imaging of Spina Ventosa (TB Dactylitis) of the foot. Radiol Case Rep 15(8):1373–1376. https://doi.org/10.1016/j.radcr.2020.05.027

    Article  PubMed  PubMed Central  Google Scholar 

  18. Hwang S, Simsir A, Waisman J, Moreira A (2004) Extrapulmonary tuberculosis as a mimicker of neoplasia. Diagn Cytopathol 30(2):82–87. https://doi.org/10.1002/dc.10416

    Article  CAS  PubMed  Google Scholar 

  19. Lemme SD, Raymond AK, Cannon CP, Normand AC, Smith KA, Hughes DP (2007) Primary tuberculosis of bone mimicking a lytic bone tumor. J Pediatr Hematol Oncol 29(3):198–202. https://doi.org/10.1097/mph.0b013e31803b959f

    Article  PubMed  Google Scholar 

  20. Tewari S, Patel R, Shah K (2023) Adverse drug reactions in drug resistant pulmonary tuberculosis patients. Indian J Tuberc. https://doi.org/10.1016/j.ijtb.2023.06.001

    Article  Google Scholar 

  21. Patil S, Bhagwat R, Mohite R, Barphe S (2017) Profile of adverse drug reactions in multiple drug resistant tuberculosis patients at drug resistant-tuberculosis center - Miraj, Maharashtra. Int J Med Sci Public Health 6(4):1. https://doi.org/10.5455/ijmsph.2017.1164201122016

    Article  Google Scholar 

  22. Jain AK, Jaggi KR, Bhayana H, Saha R (2018) Drug-resistant Spinal Tuberculosis. Indian J Orthop Mar-Apr 52(2):100–107. https://doi.org/10.4103/ortho.IJOrtho_306_17.PMID:29576636;PMCID:PMC5858202

    Article  Google Scholar 

  23. Li L, Zhang Z, Luo F, Xu J, Cheng P, Wu Z (2012) Management of drug-resistant spinal tuberculosis with a combination of surgery and individualised chemotherapy: a retrospective analysis of thirty-five patients. IntOrthop 36:277–283

    Google Scholar 

  24. Tuli SM (2002) Challenge of therapeutically refractory and multidrug resistant tuberculosis in orthopaedic practice. Indian J Orthop 36:211–213

    Google Scholar 

  25. Prakash J (2014) Sacroiliac tuberculosis - A neglected differential in refractory low back pain - Our series of 35 patients. J Clin Orthop Trauma 5(3):146–53. https://doi.org/10.1016/j.jcot.2014.07.008

    Article  PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. Central Institute Of Orthopaedics, VMMC and Safdarjung Hospital, New Delhi, 110029, India

    Jatin Prakash &  Vikas

  2. Department of Pathology, LHMC, New Delhi, India

    Jyoti Garg

Authors
  1. Jatin Prakash
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  2. Jyoti Garg
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  3. Vikas
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Contributions

All Authors contributed significantly in idea of manuscript, patient care, writing of manuscript, critically analysing and revising of manuscript.

Corresponding author

Correspondence to Jatin Prakash.

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Informed consent

Informed consent was obtained from all individual participants included in the study.

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Taken from all participants.

Conflict of interest

All authors declare that they have no conflict of interest.

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Level of evidence: Level IV

Key Points

• Foot TB is rare and often neglected differential in chronic foot pain. Clinicians must maintain a high degree of suspicion in all cases of unilateral foot pain over three weeks to diagnose these cases promptly.

• TB foot may have varied radiological presentation including lytic type, sclerotic type and spina ventosa type. All these presentation must be borne in mind while dealing the cases of chronic unilateral foot pain.

• Meticulous history and clinical examination, early MRI and timely biopsy of radiological lesion of foot is of paramount importance to help early diagnosis.

• Timely commencement of Anti-tubercular therapy is single most important factor that effects the prognosis of foot tuberculosis.

• Multi Drug resistant Tuberculosis should be kept in mind for all patients of TB foot that are not responding favourably to ATT.

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Prakash, J., Garg, J. & Vikas Unveiling foot tuberculosis as an under-recognized source of foot pain. International Orthopaedics (SICOT) 48, 389–400 (2024). https://doi.org/10.1007/s00264-023-05957-w

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  • DOI: https://doi.org/10.1007/s00264-023-05957-w

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