Osteod osteoma, although not a common clinical occurrence, does pose problems both in diagnosis and surgical management. Initial plain radiographic diagnosis is sometimes fraught with the limitation of not being able to differentiate from chronic osteomyelitis and stress fracture. CT-aided localization of the nidus is also often inconclusive. Radionuclide single photon emission computed tomography (SPECT) scintigraphy is highly sensitive in localizing the active nidus and also orients the lesion in a three-dimensional plane well, for effective surgical removal.