<p class="p p-first-last" id="__p2"><em>Mycobacterium senegalense</em> infection is rare. We present the third documented case of <em>M. senegalense</em> infection and the first to involve the musculoskeletal system. A 55-year old immunocompetent male developed chronic osteomyelitis of the ankle and required antibiotic spacers, an Ilizarov external fixator and multiple antibiotic regimens to eradicate the infection.</p>