Insight into tuberculosis of talus in children: A review of five cases

Abstract

BackgroundTubercular affection of talus in children is considered extremely rare with literature limited to few case reports. This study reports five cases of tubercular infection of talus in children and traces the various presentations and the treatment outcome.MethodsThe series describes five children with biopsy proven affection of tuberculosis of talus. Data reviewed included the demographic data, clinical presentation, diagnosis, treatment and outcome at final follow up. ResultsAmong the five cases described in this series, the majority were osseous (4/5). The location of the osseous lesions was noted in the head as well as the head-neck junction of the talus. The duration of symptoms varied from three to 12 months. Three of the five cases healed uneventfully after the initiation of standard anti-tubercular therapy with normal appearing radiographs at the latest follow up. Two cases still had small, geographic lytic lesions in the talus. These might represent healed cystic cavities filled with fibrous. ConclusionThe diagnosis of tuberculosis of talus in children is challenging. A high index of suspicion is required for patients presenting pain around the ankle and hindfoot for more than four weeks. The involvement of the talar bone in tuberculosis can be osseous or synovial. Lesions in the head and neck should particularly be investigated for tubercular etiology. Once diagnosed, antitubercular drugs are effective in healing the lesions clinically as well as radiologically. The presence of lesions in the non-weight bearing area of the talus prevents bony collapse and eventual shape is maintained.