Isolated first metatarsal tubercular osteomyelitis of the foot in a boy: A case report with review of literature

Isolated tubercular lesions of the metatarsal bones are rare, with an incidence of less than 0.5%. Because of ambiguous signs and symptoms, and reasonably normal laboratory investigations, these lesions pose a diagnostic challenge and there are chances of misinterpretation of radiographic images. We present a case of tubercular osteomyelitis of the first metatarsal of right foot in a 9-year-old boy. The diagnosis was initially made using plain X-ray, which was supported by magnetic resonance imaging and confirmed by the histopathological examination of the resected samples and microbiological culture combined with polymerase chain reaction. The patient was managed with open biopsy and curettage followed by a prolonged course of anti-tubercular treatment. The patient showed complete resolution of symptoms with no sign of recurrence.