IS Case 119: Mycetoma (Madura Foot)
Imaging Sciences URMC 2008
Publication Date: 2009-05-20
Mycetoma (Madura Foot)
Mycetoma is a debilitating chronic granulomatous disease in tropical and subtropical regions. The disease was first reported from the region of Madura in southern India. It may be caused by a fungal (eumycetoma) or bacterial (actinomycetoma) infection which forms small, subcutaneous swellings that enlarge and break through the skin surface, with concurrent invasion of deeper tissues. The clinical triad consists of painless soft-tissue swelling, skin sinuses, and discharge of colored grains. The infection may occur anywhere in the body, but most commonly enters the plantar surface of the foot in areas where people go barefoot.
- Stage 0 - Soft-tissue swelling without bone involvement
- Stage I - Extrinsic pressure effects on the intact bones in the vicinity of an expanding granuloma
- Stage II - Irritation of the bone surface without intraosseous invasion
- Stage III - Cortical erosion and central cavitation
- Stage IV - Longitudinal spreading along a single ray
- Stage V - Horizontal spread along a single row
- Stage VI - Multidirectional spread due to uncontrolled infection
The differential diagnosis of these radiographic features includes other types of osteomyelitis, neuropathic artheropathy, and neoplasm. Treatment for bacterial mycetoma include antibacterial agents if administered early in the course of the disease. Fungal mycetoma may respond partially to antifungal agents, however surgery is preferred if the disease is localized.
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