Introduction Tuberculosis involving small tubular bones like the metacarpus, metatarsus and the phalanx (tuberculous dactylitis) is a rare form of the disease. Tuberculous dactylitis may sometimes be confused with chronic osteomyelitis, metabolic disorders, sarcoidosis or malignancies, and when the correct diagnosis is made at a later stage of disease progression, severe deformities will have already occurred in the affected bones. Case presentation In this case report, we present the severe deformation of a phalanx affected by tuberculous dactylitis, which has been diagnosed and treated approximately 3 months later than the first presentation 10 years ago.