A 25-year-old man has chronic pain and swelling of the right ankle for 6 months with low-grade evening fever. Radiographs show regional osteoporosis and a lytic lesion with minimal periosteal reaction in one tarsal bone. Aspiration yields acid-fast bacilli on culture. Which tarsal bone is most commonly involved in tuberculosis of the foot?
- A Talus ✓
- B Navicular
- C Cuboid
- D Calcaneum
Correct answer: A. Talus
Explanation
In tuberculosis of the foot, the talus is the most frequently involved tarsal bone, followed by the calcaneum. Infection usually reaches the talus through the synovium of the ankle or subtalar joint, and the poor vascularity of the bone favours persistence of disease. The calcaneum is the strongest distractor because it is the largest tarsal bone and a frequent site of pyogenic osteomyelitis, but Tuli ranks it second in tuberculous involvement.
Reference: Tuli's Textbook of Tuberculosis of the Skeletal System, 5th ed.
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