Ankle tuberculosis: a report of four cases in a Japanese hospital. 
We report four patients suffering from ankle tuberculosis, which is an uncommon disease in Japan.  All patients complained of swelling and pain in the affected ankle.  Ankle tuberculosis is a disorder that can be easily misdiagnosed.  The mean delay in diagnosis was 5.3 months in our series.  All patients had already been diagnosed as having ankle tuberculosis by the time they visited our hospital in this series.  The patients had been definitively diagnosed to have ankle tuberculosis by means of a needle biopsy in two cases, an open biopsy in one case, and on the basis of the clinical features in one case.  All patients received antitubercular therapy and non-weight-bearing protective treatment.  Antitubercular therapy was performed for an average of 14.3 months, and non-weight-bearing treatment was maintained for a mean of 4.5 months.  The main treatments for such cases include open biopsy for an uncertain diagnosis, débridement for intractable synovitis, and arthrodesis for severely destroyed ankles with pain.  All patients received some form of surgical intervention either from previous doctors or from us in this series.  We conclude that most patients who suffer from ankle tuberculosis seem to need surgery in addition to adequate chemotherapy and non-weight-bearing protective treatment.