Madura foot; mycetoma pedis

Etiology

• Actinomyces (see mycetoma)
• true fungi

Epidemiology

• Actinomyces account for most cases in patients from Mexico

Clinical manifestations

• chronic edema
  • subcutaneous nodules of the foot
    • painful
    • sinus tracts with periodic draining
    • both plantar & dorsal surfaces of foot

Laboratory

• skin biopsy
  • whitish-yellow granules
  • non-acid-fast filamentous bacteria

Radiology

• CT or MRI to r/o osteomyelitis

Complications

• difficulty fitting shoes
• difficulty ambulating

Management

• long-term doxycycline for Actinomyces
• prognosis: after 8 months, patient in case report has near normal appearing foot

More general terms

• mycetoma (fungus ball, Madera foot)