Management of osteoarticular tuberculosis of the foot and ankle: a scoping review



tuberculosis, TB, foot and ankle, surgery


Background: The purpose of conducting this review was to determine the optimal medical and surgical management of patients in the adult population with foot and ankle tuberculosis from the available literature.

Methods: A systematic literature search was undertaken through PubMed, Web of Science, Scopus, and the Cochrane Library. The phenomenon of interest was defined as tuberculosis of the foot and/or ankle in patients over 14 years of age. A qualitative data description was performed and reported as per Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) guidelines.

Results: The median total duration of medical treatment was 12 months (range 6–18). Most studies used a combination of rifampicin, isoniazid, pyrazinamide and ethambutol as intensive phase treatment for a median duration of two to three months. The continuation phase involved two or three agents for up to 16 months. The most common indication for surgery in active disease was failure to respond to medical treatment alone. In quiescent disease, surgery was employed for impending midfoot collapse or painful, deformed joints. It was found that 17% of patients (32 of 184) required arthrodesis.

Conclusion: Medical treatment remains a mainstay of management. Evidence supporting surgical management in early disease is limited. No single approach, implant or fixation method for the purpose of arthrodesis has been proven superior to another. Further research is needed, specifically comparative studies to address the lack of consensus surrounding surgical intervention.

Level of evidence: Level 5

Author Biographies

Kajal Hansraj, University of KwaZulu-Natal

Department of Orthopaedics, Grey’s Hospital, University of KwaZulu-Natal, Pietermaritzburg, South Africa

Leonard C Marais, University of KwaZulu-Natal

Head: Department of Orthopaedics, University of KwaZulu-Natal, Durban, South Africa


Additional Files





Orthopaedic Oncology and Infections

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