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 declin e in notification rates in the UK has stopped and recently reversed. The re asons for this are multifactorial and are discussed briefly here. We presen t the case of an unusual presentation of tuberculosis in the metatarsal of an elderly Caucasian gentleman. This serves as a reminder to include tuberc ulosis in the differential diagnoses of unusual musculoskeletal presentatio ns.