A right-handed 18-year-old male patient reported to the outpatient orthopedic department with swelling over the distal phalanx of his left-hand little finger that was steadily expanding and producing clubbing during a 6-month period. Swelling was linked to pain, which was worse at night and relieved with NSAIDs. Physical examination revealed localized edema with clubbing of the distal region of the left little finger, as well as an expanded nail plate and a disturbed nail fold angle. On comparing to the contralateral hand, the movement range at the distal interphalangeal joint was found to be normal. Before surgery, the patient had a visual analog scale (VAS) score of 8. His blood investigations revealed no rheumatic and inflammatory illnesses, and he ruled out any history of trauma or infection. Radiographs indicated a lytic lesion of the right index finger’s distal phalanx with surrounding sclerosis, for which magnetic resonance imaging was performed, which revealed a well-defined eccentric mildly expansile intracortical lesion involving the lateral cortex of the diaphysis of the distal phalanx of the little finger, with a central hypointense sclerotic area within surrounded by diffuse marrow edema giving differential diagnosis of Osteoid osteoma Chronic osteomyelitis with sequestrum Intraosseous glomus tumor. A provisional diagnosis of osteoid osteoma was made based on clinical and radiographic data; however, additional disorders such as blastoma, glomus tumor, and infection needed to be ruled out. The patient was operated on. The distal phalanx bone was revealed and cortex punctured using a medial approach. Nidus was curated with a curate followed by excision of the sclerotic margins with no additional puncture of the opposite cortex. The curettage was confirmed with fluoroscopic guidance (). Obtained specimen was sent to pathology for further examination. The finger was immobilized with a buddy splint after surgery, and the patient experienced pain alleviation after a few days (post-surgery 10th day VAS score 3 followed by VAS score of 0–1 2 month post-operative). Confirmation of osteoid osteoma was done by histological testing. The patient was observed for 3 months and exhibited complete clinical improvement.