title: Ankle and foot tuberculosis: a diagnostic dilemma.
abstract: OBJECTIVE
  To know the biological behavior of ankle and foot tuberculosis (AFTB) and to know the reasons for delay in diagnosis and treatment of AFTB in our population.
  
  
  METHODS
  Patients with non-healing ulcers/sinuses/swellings in the ankle and foot region are the subjects of present study. Detailed clinical history, physical examination and relevant investigations were done in all cases. Pus/wound discharge for acid fast bacillus (AFB) study and biopsy from wound margin/sinus tract was taken in all the cases.
  
  
  RESULTS
  During the period from July 2007-June 2012, 20 cases of AFTB were treated. Out of them five cases were difficult to diagnose and a mean period of 6 month to 5year was elapsed before final diagnosis was established. Out of these five cases - three cases were diabetic with ulcers and sinuses in the heel and ankle region. One case was wrongly diagnosed as angiodysplasia with A-V malformation of foot and diagnosis was delayed for 5 year. In one case of rheumatoid arthritis with abscess in ankle joint, the diagnosis was delayed for 1year.
  
  
  CONCLUSIONS
  AFTB is very rare condition. AFTB is suspected in cases with long standing pain/swelling/discharging sinus in the foot and thorough investigations is must to differentiate from other foot diseases. Diagnosis is delayed due to lack of clinical suspicion and non-confirmatory biopsy reports. Early diagnosis and ATT for 9-18 months is must in all cases of AFTB to prevent joint involvement and other complications.
authors.affiliation: Department of General Surgery, S.C.B. Medical College, Cuttack, Orissa, India.
authors.forename: Biswaranjan
authors.initials: B
authors.lastname: Nayak
authors.affiliation: Department of Physiology, S.C.B. Medical College, Cuttack, Orissa, India.
authors.forename: Rashmi Rani
authors.initials: RR
authors.lastname: Dash
authors.affiliation: Department of General Surgery, S.C.B. Medical College, Cuttack, Orissa, India.
authors.forename: Kailash Chandra
authors.initials: KC
authors.lastname: Mohapatra
authors.affiliation: Department of Pulmonary Medicine, S.C.B. Medical College, Cuttack, Orissa, India.
authors.forename: Geetanjali
authors.initials: G
authors.lastname: Panda
keywords: Ankle; foot; tuberculosis