Verrucous carcinoma is an uncommon complication of chronic osteomyelitis. The incidence of fistular carcinomas is reported to be between 0.21% and 3.36%. We present a case of verrucous carcinoma of the tibia arising after 58 years of chronic osteomyelitis. The primary presenting symptoms were acute pain, foul-smelling pus discharge and increasing lesion size. We used modern diagnostic investigations (biopsy, computed tomography, angiography, immunoscintigraphy, magnetic resonance tomography) to visualize the extent of the malignant lesion. No metastases were detected. Knee exarticulation was successful in treating the tumor and chronic infection in this case.