Clinical Picture: Madura Foot

Madura foot is a chronic infection of the skin and underlying tissues caused by both bacteria (actinomycotic mycetoma or actinomycetomas) and fungi (eumycetomas or mycotic mycetoma). Mycetoma occurs most often in people who work in rural areas, usually in farmers, hunter-gatherer populations, and field laborer. The disease was first described in the Indian town of Madura. Lower extremities involvement is more common. Our patient, 26-year-old agricultural worker, presented with 1-year history of recurrent swellings, itching, and chronic purulent discharge from his right foot. On examination, he had multiple small swellings of the right foot and indurations with sinus tracts discharging pus. The classic clinical triad of mycetoma is soft tissue swelling, sinus tracts, and characteristic macroscopic grains. Grains contain aggregates of the causative organisms that may be discharged onto the skin surface through multiple sinuses. Bone radiography may show cortical thinning, cortical hypertrophy, or multiple lytic lesions. Disuse osteoporosis may occur in late stages mycetoma. Medical therapy in a form of antibiotic or antifungal alone may be sufficient for actinomycetoma, but surgery is generally needed for eumycetoma. Madura foot is an uncommon entity in the west but still seen in the rural areas of India.