Tuberculosis of the midfoot: A rare case report

With the incidence of TB on the rise, despite rare involvement in the feet, TB can be difficult to diagnose in the feet leading to delayed treatment and severe complications. A 67 year old women presented at our outpatient clinic with a spontaneously occurring abscess and pain of the right foot. Initially, she was treated for a gout attack. However, after four months, X-ray and MRI imaging revealed extensive osteomyelitis and bony destruction of the midfoot. Diagnosis was established through tissue biopsy. She was treated with anti-tubercular therapy for 10 months during which the foot was immobilized in a total contact cast. Stabilization of the foot was achieved by two-stage operation utilizing fusion beams commonly used in het treatment of Charcot arthropathy. Tuberculosis of the foot can be difficult to diagnose, therefore a high level of suspicion is recommended for cases not responding to conventional therapy, even in the Western world. Early recognition and treatment with anti-tubercular therapy, the cornerstone in TB treatment, can prevent permanent damage. Surgical reconstruction is reserved for the most severe cases to correct deformity and prevent disability.