title: Tuberculosis of the foot and ankle in children.
abstract: OBJECTIVE
  To report manifestations and management of tuberculosis of the foot and ankle in 21 children.
  
  
  METHODS
  Records of 12 girls and 9 boys aged 3 to 14 (mean, 7) years with tuberculosis of the foot and ankle were reviewed. The mean delay in presentation was 4.7 (range, 0.5-14) months. All the patients had local swelling, tenderness, and antalgic gait; 16 were limping; 5 had an antecedent trauma; 11 had an abscess; and 6 had a discharging sinus. The diagnosis was based on a smear positive for acid-fast bacilli (n=2), histopathology (n=15), or clinicoradiological findings (n=4). Nine patients had osteoarticular tuberculosis in other parts of the body. None had evidence of pulmonary tuberculosis. Lesions were classified into synovial (articular) and osseous. All 3 synovial lesions occurred in the ankle, 2 of which were at an advanced stage. Osseous lesions occurred in the calcaneus (n=5), metatarsal (n=5), talus (n=3), cuboid (n=3), medial cuneiform (n=1), and phalanx (n=1), and were sub-classified into stages 1 (n=3), 2 (n=5), and 3 (n=10) according to disease progression. All the patients were treated conservatively with splintage and chemotherapy.
  
  
  RESULTS
  The mean follow-up period was 21 (range, 7-51) months. All the 3 patients with stage 1 osseous lesions showed healing within 6 weeks and had complete recovery of function. Four of the 5 patients with stage 2 lesions also showed complete recovery of function and reformation of bony trabeculations; radiological incorporation of sequestrum was obvious by 6 months in most patients. In patients with stage 3 lesions, healing was delayed and there was residual alteration in bony architecture and joint changes. Sclerotic changes and joint involvement also increased the likelihood of poor outcomes. However, none of our patients had any residual tenderness or foot deformity at the final follow-up.
  
  
  CONCLUSIONS
  Outcome after non-operative treatment is good, provided the lesions are treated early.
authors.affiliation: Department of Paediatric Orthopaedics, CNBC, Geeta Colony, Delhi, India. rachna_anila@yahoo.co.in
authors.forename: Anil
authors.initials: A
authors.lastname: Agarwal
authors.forename: Nadeem Akhtar
authors.initials: NA
authors.lastname: Qureshi
authors.forename: Shariq Azam
authors.initials: SA
authors.lastname: Khan
authors.forename: Pawan
authors.initials: P
authors.lastname: Kumar
authors.forename: Sachin
authors.initials: S
authors.lastname: Samaiya
mesh_terms: D000293:Adolescent; D000843:Ankle Joint / Q000000981:diagnostic imaging; D001851:Bone Diseases, Metabolic / Q000000981:diagnostic imaging; D002111:Calcaneus / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005534:Foot Diseases / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000000981:diagnostic imaging / Q000382:microbiology; D011859:Radiography; D012189:Retrospective Studies; D012598:Sclerosis; D013628:Talus / Q000000981:diagnostic imaging / Q000382:microbiology; D014394:Tuberculosis, Osteoarticular / Q000175:diagnosis / Q000628:therapy*