An Unusual Development of a Madura Foot: A Case Report

Abstract

Mycetomas are chronic inflammatory pseudo-tumoral lesions caused by fungal or bacterial agents developing in subcutaneous soft tissues and bone. Mycetoma is frequently located in the foot, realizing the Madura foot. We report the case of a 42-year-old male farmer, who presented two years following an injury to the plant of the right foot. He already had two excisions elsewhere with recurrence and aggravation of the swelling. He had a large painless subcutaneous swelling of his right foot with plantar sinuses discharging pale white and yellow grains. A surgical biopsy with histological study confirmed the diagnosis of mycetoma. He received an antibiotic therapy consisting in penicillin G followed by amoxicillin then an association of penicillin G and co-trimoxazole during almost three years without any improvement. A below-knee amputation was performed complicated with necrosis and infection of the stump, which was resumed twice followed by an above-knee amputation. Through this case of unusual development of a Madura foot we discuss the diagnostic and especially therapeutic difficulties of this chronic infection.