Peripheral skeletal infections caused by Mycobacterium are widely reported in the literature. Unfamiliarity with this disease, or oversight caused by inexperience may result in failure to thoroughly investigate the presence of this organism. An unusual case of tuberculous osteomyelitis involving the second digit of the foot is presented. The authors emphasize the importance of including cultures of acid-fast bacillus in the work-up of atypical infectious processes of the foot and ankle, and include Mycobacterium in their differential until it is positively ruled out. An in-depth radiologic review is included.

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