Tuberculous Osteomyelitis of Calcaneum: A Rare Case.

Tuberculosis (TB) is a major public health challenge in rapidly developing economies. TB commonly affects the lungs but, in rare cases, can spread to other organs such as intestines, bones, and lymph nodes. Tuberculous osteomyelitis (OM) of calcaneum in adults is rarely encountered and not very commonly reported in the literature. Most of the cases are either misdiagnosed or treating physicians often face significant delays in diagnosing Tuberculous OM of the calcaneum. We report the case of a female in her mid-thirties who had a known case of pulmonary TB for the past 10 years with tuberculous OM of the left calcaneum for three years. Initially, she was able to bear weight over her heel and walk normally, but for the past year, she was unable to bear weight over her left heel and walked with toe tips. Although being a known case of TB, the patient gave no history of any significant weight loss, even a rise in temperatures, or any systemic complaints. Tubercular OM of the calcaneum is an extremely rare clinical entity, which commonly leads to delay in diagnosis and further delay in therapeutic intervention. Patients who present with chronic osteo-articular lytic infections with past history of TB should be suspected of having osteo-articular infection with tuberculous bacilli and must be evaluated. Based on the current case scenario, the tubercular OM of the calcaneum should be diagnosed early and prompt treatment in the form of anti-tubercular therapy (AKT) should be initiated. Most cases respond well to conservative treatment in a few weeks after starting AKT. Surgical intervention should be reserved in cases refractory to conservative management or those with extensive soft tissue or joint involvement with discharging sinuses. In such cases, sequestrectomy and curettage with surgical excision of the sinus tract are needed.