Case: We report the case of a 50-year-old woman with oncogenic osteomalacia secondary to a metastatic phosphaturic mesenchymal tumor (PMT) that presented, to our knowledge, with the first reported lesion in the talus.
Conclusion: Oncogenic osteomalacia is a rare condition with a unique serum biochemical profile that requires a high index of suspicion for diagnosis. A PMT is a rare neoplasm that can lead to oncogenic osteomalacia through secretion of fibroblast growth factor 23. Symptoms can be debilitating, and diagnostic delays are extremely common. This case report emphasizes the importance of comprehensive anatomic assessment and the need for fastidious postoperative monitoring.