Qaiser Hussain, Shahid Majeed, Rizwan Aslam, Ghani Qureshi.
Mycetoma (Madura Foot).
Pak Armed Forces Med J Jan ;51(1):66-7.

A middle aged lady resident of Daska (Sialkot) presented with history of swelling of right foot and multiple discharging sinuses, for the last 12 years. She being resident of rural village had positive history of walking bare foot in the fields and at home. Initially she developed a small wound on the medical aspect of her foot which persisted for a few months followed by development of a single sinus, with yellowish colored discharge. Over the time thedisease kept on prorgessing and she developed swelling of her foot associated with formation of multiple discharging sinuses all over the foot. The swelling persistantly increased and spread over the whole foot with increasing number of examination she was enjoying good bodily health with no sequelae of this chronic disfiguring illness. Examination of her right foot revealed an enormously enlarged and disfigured foot almost three to four times, its normal counterpart. There was marked hyperpigmentation of the skin with non pitting oedema of the tissue and multiple discharging sinuses on the dorsum and sole of the foot [Fig 1 &2]. On pressure sinuses exuded yellowish colored discharge. Sole also revealed numerous healed sinuses. The movements of ankle, subtalar and midtarsal joints due to extensive bone destruction[Fig 3] were severely restricted. Above the ankle joint she did not have any other lesion. There was no inguinal lymphadenopathy. Rest of systemic examination was unremarkable. Incisional biopsy report suggested madura foot. Below knee amputation was performed and subsequently her wound healed satisfactorily.

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