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Case report
Tubercular involvement of the lateral malleolus and adjacent calcaneus: presentation of a rare case and review of the literature
  1. Prasoon Kumar,
  2. Mandeep Singh Dhillon,
  3. Rajesh Kumar Rajnish and
  4. Karan Jindal
  1. Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  1. Correspondence to Dr Rajesh Kumar Rajnish; duktiraj{at}


Osteoarticular tuberculosis (TB), despite being on the wane in the developed world, stays a problem of significance in the developing world. The issue is compounded by unusual presentations, inadequate diagnostic skills and limited understanding of its management. For foot infections, despite an increased awareness, many patients may be misdiagnosed, with associated treatment delays. A 19-year-old man presented with pain and swelling on lateral aspect of right ankle for 2 months. The patient had an undermined discharging sinus with surrounding induration and the skin adherent to the underlying bone. Patient was diagnosed as a case of ipsilateral TB lateral malleolus and calcaneus, managed with antitubercular drugs with complete resolution at 3 years of follow up. Foot and ankle TB can have atypical presentations causing delay in diagnosis. Contiguous spread of infection occurs through the synovium or the joint; however, extra-articular spread along the tendon sheaths or other soft tissues is possible, which is highlighted by the present case.

  • infections
  • musculoskeletal and joint disorders
  • bone and joint infections
  • orthopaedics
  • tuberculosis

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  • Contributors PK: writing and editing of manuscript. RKR: data search, compilation and analysis. MSD: conceptualisation and planning. KJ: biopsy and literature search.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.