Tuberculosis of the Tarsal Bone and Surrounding Joints

　　1. Etiology

　　Caused by the infection of tuberculosis bacteria through the blood circulation.

　　2. Pathogenesis

　　Since there is less synovium in the tarsal inter-joint spaces and surrounding joints, simple synovial tuberculosis is rare, and in clinical practice, simple bone tuberculosis and total joint tuberculosis in the middle and late stages are more common. Calcaneal tuberculosis is mostly central type, accompanied by necrotic bone formation; occasionally, there is marginal type. Pus is mostly collected at the lateral side of the calcaneal tuberosity, and after erosion, sinus tracts are formed, which may not heal for a long time. Such cases are often found in rural and remote areas. The lesion above the anterior superior part of the calcaneus can invade the talocalcaneal joint and talocalcaneonavicular joint, and it is also easy to invade the talocalcaneal joint.

　　Due to the interconnection of other tarsal inter-joint spaces, the disease often presents as total joint tuberculosis, and it can simultaneously affect adjacent tarsal bones or most tarsal inter-joint spaces. At this time, pus can penetrate the sheath to produce tendinous sheath tuberculosis.

　　By the late stage of the disease, the tarsal bone tuberculosis lesion may involve all the tarsal bones and tarsal inter-joint spaces, and in this case, it is called total foot tuberculosis. The affected foot may have several sinus tracts, and they often do not heal for a long time. In the later stage, there may be a possibility of canceration, resulting in the necessity of amputation.

　　In the late stage, joint fibrous ankylosis may occur. Joint ankylosis usually has a latent onset, with no clinical symptoms in the early stage. Some patients may show mild systemic symptoms in the early stage, such as fatigue, weight loss, chronic or intermittent low fever, loss of appetite, and mild anemia. Due to the mild condition, most patients cannot be detected early, leading to delayed treatment and losing the best treatment opportunity.

　　1. Symptoms and signs

　　Patients with tarsal bone tuberculosis often have lung or other tuberculosis, therefore, they have systemic symptoms such as weight loss, anemia, low fever, and so on. Local symptoms are mainly pain and limping. The symptoms of simple bone tuberculosis are relatively mild, while those of total joint tuberculosis are more severe.

　　The signs include local abscesses, tenderness, and limited joint function, accompanied by sinus tracts.

　　2. X-ray manifestation

　　The X-ray manifestations conform to the general development规律 of spongy bone tuberculosis. The early calcaneal central tuberculosis presents as a sandblasted glass-like change, followed by necrotic bone separation; after the absorption of necrotic bone, cavities are formed with denser bone walls. After long-term mixed infection, the calcaneus has obvious sclerosis.

　　The X-ray films of other tarsal bone tuberculosis are similar to those of calcaneal tuberculosis, but they quickly involve the adjacent joints or affect the adjacent tarsal bones. In the late stage, the tarsal bones may have extensive destruction and present relatively dense, while the uninvolved bones of the foot show obvious osteoporosis, with some only remaining the outline of the bone cortex, resembling the circles in charcoal paintings.

　　Firstly, active prevention of tuberculosis should be carried out for bone and joint tuberculosis. Controlling the source of infection, cutting off the route of transmission, enhancing immunity, and reducing susceptibility are the basic principles for controlling the spread of tuberculosis.

　　1. If respiratory symptoms such as coughing last for a long time, one should be vigilant about the possibility of tuberculosis.

　　2. If tuberculosis is suspected, one must go to a tuberculosis specialist hospital for treatment.

　　3. Tuberculosis patients must follow the doctor's advice, take regular medication, adhere to the full course of treatment, and cannot discontinue medication on their own.

　　4. During the medication period, visit the doctor regularly and pay attention to the side effects of the drugs.

　　5. It is necessary to do drug sensitivity tests and use drugs scientifically and reasonably.

　　If it is total joint tuberculosis, the erythrocyte sedimentation rate can increase.

　　Mainly observed on X-ray films, the early stage of central tuberculosis of the talus shows a sandblasted glass-like change on X-ray films, as if the talus is in the mist; but as the course of the disease develops, local dead bone separation, absorption, and the formation of cavities, at this time, the bone wall is dense, and if there is mixed infection, the talus can also be accompanied by hardening changes, and sinus tracts do not heal for a long time. The X-ray manifestations of other talus tuberculosis and talus tuberculosis are similar, easy to spread to other talus and talus inter-joint, in the late stage, the talus is widely destroyed, the other foot bones not involved are due to disuse and present with high osteoporosis, showing carbonization-like changes, as if only the outline of the bone cortex remains visible.

　　CT and MRI examinations are only suitable for early diagnosis cases that are not clear, generally do not need such examinations.

　　First, the diet for the treatment of talus and surrounding joint tuberculosis

　　5000 grams of white radish, washed and chopped, put into the pot with an appropriate amount of water, boiled, remove the residue, continue to cook until it becomes a black ointment-like substance. In addition, with 60 grams of saffron and 30 grams of clove flowers, add 1500 milliliters of water, boil to 500 milliliters, mix with the radish ointment, and cook again until it becomes a paste, pour it into a porcelain jar, seal the mouth, bury it underground 1 meter, and it can be used after 6 months. When using, spread the ointment on the cloth and paste it on the affected area, or fill the hollow area, change the medicine once a day or every other day.

　　Second, what is good for the body in the treatment of talus and surrounding joint tuberculosis?

　　1. Patients with bone and joint tuberculosis can also eat more marine products such as seaweed, deep-sea fish, and prawns. The nutritional value of marine life is very high. Inspection shows that every 100 grams of shrimp meat contains 20.6 grams of protein, and also contains fat, ash, and calcium, phosphorus, iron, vitamins, and riboflavin, etc. The body also contains myosin and actin, so it is not only a delicacy but also has the functions of kidney-nourishing and Yang-tonifying, nourishing Yin and strengthening bones, and calming. It can be used to treat various diseases such as tetany of hands and feet, skin ulcer, chickenpox, muscle and bone pain, bone tuberculosis, etc.

　　2. The appetite of patients with bone and joint tuberculosis is particularly poor. To increase appetite, one can focus on cooking, making the variety diverse, and ensuring good color, smell, taste, and shape. Those who have the conditions can add two snacks in addition to the three regular meals a day.

　　3. Consume high-protein, high-calorie, high-vitamin, easily digestible diet to increase nutrition, improve the overall weak condition, enhance resistance and repair ability. Eat more millet, wheat, beans, corn, and various fresh vegetables and dried and fresh fruits such as lily, tremella, longan, walnut, chestnut, jujube, white sesame, watermelon, orange, apple, pear, cucumber, cabbage, lotus root, etc.; various high-protein foods such as chicken, lean pork, lean beef, eggs, and various marine fish, etc.

　　Thirdly, what foods should be avoided for tarsal and surrounding joint tuberculosis?

　　1. Avoid spicy foods such as chicken, goose, pigeon, mountain chicken, and sparrow meat, as they can worsen local redness, swelling, and pain.

　　2. Avoid fishy and pungent foods such as fish, shrimp, crabs, eels, etc., as they can exacerbate symptoms if there is fistula infection and inflammation.

　　3. Avoid sour and spicy foods. Sour foods have the effect of retaining pathogenic factors, and spicy foods have the effect of dispersing and warming. Foods such as plums, lemons, hawthorn, pears, and mutton are acidic foods and are more harmful than beneficial. Spices such as chilies and leeks should be avoided.

　　4. Avoid high-fat, fried, and stir-fried foods. Overeating greasy foods can generate heat in the stomach, damage the spleen and stomach function, and should not be overeaten.

　　5. Avoid fad diets, as patients with this condition are often weak and should have a wide variety of foods. Fad diets can weaken the body's resistance and are not conducive to recovery.

　　6. Eat less or not eat fish, especially scaleless fish or unrefrigerated fish. Because fish contain a large amount of histidine, which can be converted into histamine in the human liver and then oxidized and inactivated by monamine oxidase. Isoniazid, an antituberculosis drug, can inhibit monamine oxidase in the human body, causing a large accumulation of histamine in the human body, leading to allergic reactions. Mild symptoms include headache, nausea, skin redness and itching, and conjunctival congestion. Severe symptoms include palpitations, numbness and tingling of the lips and face, rash, abdominal pain, diarrhea, and difficulty breathing, so it should also be avoided.

　　1. Non-surgical treatment is used for cases without obvious dead bone. Methods such as rest, local immobilization, and the application of anti-tuberculosis drugs.

　　2. Lesion excision can be performed for patients with obvious dead bone, an abscess about to rupture, or those who are ineffective with non-surgical therapy and have no surgical contraindications.

　　3. After the complete excision of one of the three main bones of the adult foot (calcaneus, talus, cuneiform bone), it is still possible to maintain quite good function. When excising the lesion, it is necessary to consider the rearrangement of the foot bones, planned osteotomy modification, and bone grafting to preserve the function of the foot. For example, when the cuneiform bone is completely excised, part of the cuboid bone should be excised.

　　4. Other individual tarsal bone lesions can also be excised. It does not hinder surgery if there is a cold abscess and fistula. The key is that there should be no tension when the skin is sutured after the lesion is excised, and the excision of the skin should be as little as possible to ensure the success of the surgery.