Tubercular Osteomyelitis of Cuboid

Tuberculosis (TB) affection of foot appears to be a rare clinical entity and accounts for <10% and 0.1-0.3% of osteoarticular and extrapulmonary TB, respectively. In TB foot, tarsal joints and calcaneum are more commonly affected followed by talus, distal end of first metatarsal, navicular, cuneiforms, and cuboid bones.

A 24-year-old female presented with pain and swelling over dorsum of the left foot from the past 8 months. On examination, there was a diffuse round shaped, solitary swelling measuring about 3.5 cm × 2.5 cm (approx.) with its surface smooth, non-pulsatile, non-fluctuant, non-transilluminant, non-compressible, and non-reducible present over dorsum of the left foot. Radiographic investigations revealed osteolytic lesion over the base of 3rd, 4th, and 5th metatarsals, middle and lateral cuneiforms and cuboid bones along with soft tissue swelling and diffuse transient osteopenia. Under spinal anesthesia, trucut biopsy of the mass revealed paucibacillary type of TB in histopathological examination. The patient was provided with ATT drugs in the form of intensive phase drugs (HRZE) daily for 4 months and continuation phase drugs (HRE) daily for 10 months according to the weight of the patient. The patient was followed up with erythrocyte sedimentation rate and C-reactive protein every 2 months once. The patient achieved a normal range of movements in the midtarsal joints except for the painful terminal range of movements. The patient was still under our follow-up.

The cuboid is the second most involved tarsal bone. The diagnosis is not always frankly evident, and a high index of suspicion has to be maintained. Surgical intervention should be limited to biopsy only as multidrug chemotherapy alone is sufficient to achieve complete healing.