Osteoarticular tuberculous infection of the first tarsometatarsal joint - a case report

INTRODUCTION: The prevalence of osteoarticular tuberculosis is increasing. Tuberculous infection in midfoot is rare. Establishing the diagnosis is difficult, leading to delay in management and leave many complications. CASE PRESENTATION: An 18-year-old man presents to our clinic with pain on his foot for the last 1 year. No other remarkable signs and symptoms. X-ray of his foot shown destruction of the 1st tarsometatarsal joint, later confirmed with MRI that shown synovitis and bone edema. Mantoux test and biopsy were done and established the diagnosis of tuberculous infection. CLINICAL DISCUSSION: Intensive phase of anti-tuberculosis chemotherapy was given for 2 months, followed by continuation phase for 7 months. Surgical management of debridement and arthrodesis were performed as adjunctive treatment. At 10 months follow-up patient was pain free, fully weight-bearing and no signs of further destruction. CONCLUSION: Osteoarticular tuberculosis is difficult to diagnose, a high index of suspicion is required to avoid delay treatment and complications. Anti-TB chemotherapy is still the treatment of choice, with surgical management is reserved for advance case.