Tubercular osteomyelitis of calcaneum in an immunocompetent adult

Tuberculosis (TB) affecting calcaneum is relatively rare in immunocompetent adults. Due to its nonspecific presentation and the absence of constitutional symptoms of TB, diagnosis is often delayed. The authors present a case of TB of calcaneum in a young male. A 20-year-old male presented with persistent pain and mild swelling of the right heel for 6 months. Upon evaluation with radiographs, a lytic lesion was noted in the posteromedial aspect of the right calcaneum. Magnetic resonance imaging was done and was reported as subacute osteomyelitis with Brodie's abscess. An open biopsy was performed and the obtained tissue was sent for histopathological examination. Histopathology showed features suggestive of Koch's etiology. All the microbiological investigations, including polymerase chain reaction for TB were negative. The patient was started on antitubercular therapy (ATT) based on weight. After 4 months of ATT, the patient developed multiple discharging sinuses over a previous open biopsy scar for which repeat debridement was done. After 12 months of ATT, the patient was asymptomatic, and radiologically, the lesion was healed. Early diagnosis and treatment with ATT will prevent massive destruction and collapse of the calcaneal body and further spread into the subtalar joint. Repeated debridements may be needed in case of nonhealing discharging sinuses to decrease the local infection load.