Tuberculosis of the Talonavicular Joint A Case Report

Abstract

Extrapulmonary, extraspinal tuberculosis is underreported despite being a common presentation of tuberculosis in the Philippines. The ankle and the smaller joints of the foot are infrequent locations of tuberculosis. A 41-year-old female presented with a six-year history of left midfoot swelling, pain, and limited ankle dorsiflexion following trauma. She underwent several wound debridements, with inconclusive biopsy findings. Radiographs showed cortical irregularities with sclerotic changes of the talus and navicular bones, and MRI revealed synovitis with associated bony erosive changes and marrow edema. Debridement, sequestrectomy, and application of antibiotic-laden cement were done. Histopathology revealed caseating necrosis, confirming the diagnosis of tuberculosis. She underwent eight months of antituberculosis therapy. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) remained normal postoperatively. After two months, the patient underwent removal of antibiotic cement and talonavicular arthrodesis with iliac bone grafting. Follow-up radiographs showed incorporation of the graft with no implant loosening. Patient eventually recovered full weight bearing of the left foot with minimal pain. Diagnosis was difficult due to the insidious onset and non-specific symptoms, delaying treatment and allowing progression of the disease. Antituberculosis therapy (ATT) is the mainstay of treatment of bone tuberculosis, and should be initiated upon diagnosis. Surgical intervention depends on the extent of bony destruction and joint instability.