This chapter discusses tuberculous osteomyelitis. Pathologically the onset of tuberculous focus is always located within the bone. In children, the disease develops differently, especially in short tubular bones. Isolated bone involvement without spreading to the joint occurs commonly in ribs, metacarpals, metatarsals, calcaneus, femur, tibia, fibula, radius, humerus, sternum, facial bones, pelvis, and skull. The common presenting features are pain, swelling of bone with warmth and tenderness, overlying boggy swelling of soft tissues, abscess or sinus formation and enlargement of regional lymph nodes. High suspicion index and detection of typical tubercular sinuses, ulcers or cold abscesses are of great clinical significance. Treatment of tuberculous osteomyelitis is also discussed in this chapter.