Beyond the Lung: A Rare Presentation of Tuberculosis in the Tarsometatarsal Joint Treated With Chemotherapy, Surgical Debridement, and Fusion

Foot tuberculosis is rarely reported in the literature, with most tuberculosis of the foot being an uncommon manifestation of skeletal tuberculosis. Early diagnosis and timely medical and surgical intervention can significantly reduce morbidity. A 23-year-old male presented with persistent swelling and pain in his right foot for six months, accompanied by a discharging sinus over the affected area in the last week, making weight-bearing increasingly difficult. Examination revealed cystic swelling near the cuboid bone, along with constitutional symptoms. Imaging studies, including X-ray and CT, showed osteopenia, bony erosions, and subluxation of the calcaneocuboid joint. MRI identified an abscess on the lateral aspect of the foot. Although aspiration and swab cultures were negative, the patient was empirically started on antitubercular therapy (ATT). Surgical debridement and fusion of the calcaneocuboid joint were performed using K-wires and tricortical bone grafts. A biopsy confirmed the diagnosis of tuberculosis. After completing nine months of ATT, the patient showed significant improvement, achieving a healthy scar and a functional plantigrade foot. Biopsy and synovectomy, combined with chemotherapy, are essential treatments for skeletal tuberculosis. The interconnected nature of midfoot joints allows untreated osseous disease to spread, potentially causing joint instability, restricted movement, and poor functional outcomes. Early joint stabilization in the correct alignment is vital to prevent deformities. Similar to spinal tuberculosis management, radical debridement and bone grafting are effective in midfoot tuberculosis. Debridement reduces the infectious load, while bone grafting provides a stable framework to minimize recurrence and promote joint fusion. This approach not only alleviates pain but also enhances the patient's functional recovery.