Isolated CC joint tuberculosis – A diagnostic dilemma

• Tuberculosis is making a world-wide come back due to emergence of HIV and also due to large scale population emigration from the developing to developed world.
• A lytic lesion in the foot raises multiple diagnostic possibilities like infections (bacterial–tuberculosis, bacterial/fungal–maduramycosis), rheumatoid foot, neuropathic joints among others.
• Calcaneo-cuboid joint is a rare site for localization of tuberculosis.
• Key to a good functional result is early diagnosis and adequate medical therapy.
• Rarely, patients persisting to have residual pain due to joint incongruity may need arthrodesis.

Painful lytic lesions of the foot raise a diagnostic dilemma for the foot surgeon. The localization of the lytic lesion in the mid foot is rare and isolated involvement of the calcaneo-cuboid (C–C) joint is even rarer. Early diagnosis is imperative in the mid foot to avoid rapid disease spread due to multiple venous interconnections. The diagnostic possibilities include infection, tumor (primary and metastasis), inflammatory arthritis, foreign body prick among others. The clues to rule out other differential diagnoses of lytic lesions can be history and examination, both clinical and radiographic but the gold standard for final diagnosis remains biopsy and histo-pathological examination. We describe two cases of lytic lesion around the calcaneo-cuboid joint and discuss the diagnostic dilemma. The lesions were diagnosed as tubercular in nature after histo-pathological examination of open biopsy. Both cases had complete resolution of lytic lesions and had fair functional outcome after completing the course of anti-tubercular therapy. Tuberculosis (TB) is making a worldwide resurgence due to the epidemic of HIV. In order to control this global epidemic of TB, it is important to know about all the possible presentations of the disease, including rare ones. Tuberculosis if diagnosed early in the disease course, when the pathology is localized, can result in good to fair results in the foot if adequately managed by anti-tubercular therapy.Level of evidenceV.