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| Fig. 32.4 Madura foot. Swelling and deformity of the foot and ankle with purulent drainage and fistula formation. |
Madura foot is an indolent localized painless infection with three characteristic features. The first is the formation of nodules in the skin at the site of inoculation, usually a penetrating injury. The second feature is purulent drainage and fistula formation. The third and most characteristic feature is the presence of grains or granules that are visible in the purulent drainage. Seventy percent of cases involve the lower extremity, the foot in particular. Other sites of infection include the hand, head, back, and chest. Madura foot is a progressive infection leading to marked swelling and deformity in its latter stages (Fig. 32-4). Additionally, the lesions have a tendency to become painful in the latter stages, when bone involvement and deformity ravage the site. Eumycetomas are extremely difficult to manage and include medical, surgical, or a combination of both. Itraconazole and terbinafine are the most commonly used antifungal agents and are more effective than ketoconazole.
