Two-stage Reconstruction for Chronic Tuberculous Midfoot Osteomyelitis in Diabetic Patient: A Limb Salvage Case Report

REPORTand swelling over the right midfoot.Symptoms began insidiously and gradually worsened, leading to difficulty in ambulation.He reported intermittent low-grade fever over the past few months.There was no history of an ulcer over the right foot.Despite multiple courses of oral antibiotics prescribed elsewhere, there was no significant improvement, and he had been advised belowknee amputation.The patient denied any history of trauma, recent surgery, or foot ulcers secondary to diabetic neuropathy.There was no prior history of pulmonary TB or contact with a known case of TB.There were no relevant past interventions and lined outcomes. CliniCal FindingsOn significant finding of physical examination, the right foot showed a localized rise in temperature with diffuse swelling over introduCtion Chronic osteomyelitis of the midfoot, especially when caused by tuberculosis (TB), is a rare but significant condition, often leading to considerable morbidity.TB accounts for 1-3% of all osteoarticular infections, with the foot being involved in about 10% of these cases. 1 Interestingly, patients with osteoarticular TB do not present with pulmonary symptoms, complicating diagnosis.The presence of diabetes mellitus further complicates the situation, as it impairs wound healing and weakens the immune response. 2Given its uncommon nature and the ability to mimic other conditions, such as pyogenic osteomyelitis, inflammatory arthritis, osteochondrosis, Charcot arthropathy, or malignancy, the diagnosis of TB-related osteomyelitis in the foot is often delayed.This delay in diagnosis can hinder timely and effective treatment, leading to worsened outcomes. 3 This case study highlights a 60-year-old male with controlled diabetes mellitus who developed chronic midfoot osteomyelitis secondary to TB.The case emphasizes the importance of early detection and intervention in such rare and complex cases.A novel surgical approach for limb salvage and functional restoration was used in this patient, aiming to address both the infection and the structural challenges caused by the disease.To our knowledge, such a strategy remains underreported in existing literature, especially in tuberculous osteomyelitis.This approach offers valuable insights for improving patient outcomes in managing chronic osteomyelitis, particularly in those with complicating factors like diabetes and rare infectious causes such as TB. Case desCriptionA 60-year-old male with well-controlled diabetes mellitus presented with a 6-month history of gradual progression of pain 1-