The painless fracture: could it be TB?

Tuberculosis is one of the commonest infections world-wide, with one third of the world's population carrying the bacillus. Since the 1980s the decline in notification rates in the UK has stopped and recently reversed. The reasons for this are multifactorial and are discussed briefly here. We present the case of an unusual presentation of tuberculosis in the metatarsal of an elderly Caucasian gentleman. This serves as a reminder to include tuberculosis in the differential diagnoses of unusual musculoskeletal presentations.