Tuberculosis of the First Metatarsophalangeal Joint Treated With Metatarsal Head Resection and Anti-tuberculous Chemotherapy: A Case Report

Tuberculosis of the foot is an uncommon form of extrapulmonary tuberculosis, and tuberculosis of the first metatarsophalangeal (MTP) joint is extremely rare. We report the case of a healthy 31-year-old woman from the Philippines with a three-year history of swelling and pain in her left first MTP joint. Foot imaging revealed severe bone destruction and granulation tissue formation at the first MTP joint. Chest imaging showed no pulmonary involvement. <i>Mycobacterium tuberculosis</i> was identified from the granulation tissue at the first MTP joint, leading to a diagnosis of isolated tuberculosis of the first MTP joint. Surgical debridement, including resection of the first metatarsal head, was performed, followed by a six-month course of anti-tuberculous chemotherapy. Throughout the three-year postoperative follow-up period, the patient exhibited no symptoms or radiographic signs suggestive of infectious relapse. This case underscores the importance of considering skeletal tuberculosis in chronic monoarthritis of the first MTP joint, even in the absence of pulmonary symptoms. To our knowledge, previous reports of tuberculosis in the first MTP joint have been limited to short-term follow-up. This case demonstrates the effectiveness of combined metatarsal head resection and anti-tuberculous chemotherapy in achieving sustained infection control over the mid-term follow-up.