The role of computed tomography in the exploration of Madura foot (pedal mycetoma)

Chronic swelling of the foot

“…The characteristic triad includes a painless subcutaneous mass, draining sinuses, and exuding Bgrains^representing either a conglomerate of fungal hyphae [1,6,7], or bacteria in microabscesses [8], although these findings may not be present until the advanced stages, when extensive bone and soft tissue damage has already occurred [4]. Moreover, constitutional symptoms and signs are rare and may occur only after secondary bacterial infection of open sinuses [1].…”

“…It is endemic in equatorial, tropical, and subtropical regions, including the Middle East [1,4,5], but is not well known in the USA and Europe [5], except in migrant populations [7]. Data on its prevalence have been few and far between.…”

“…It may be confined to the soft tissues for years [4][5][6], but has the potential for imminent osseous changes such as periosteal reaction and cortical erosion that almost always commences from the outside, in contrast to the centrifugal spread typical of bacterial osteomyelitis [1].…”

“…Mycetoma, first described in the Madura district of India in 1842 [1][2][3], is a clinical entity referring to a chronic, debilitating, granulomatous disease of soft tissues, usually of the foot, resulting from infection either with filamentous bacteria (actinomycetoma) or true fungi (eumycetoma) [1,2,[4][5][6]. It is endemic in equatorial, tropical, and subtropical regions, including the Middle East [1,4,5], but is not well known in the USA and Europe [5], except in migrant populations [7].…”

“…The disease is usually slow and painless [5], with the organism first lodging in the soft tissues typically as an aftermath of skin trauma [1,[4][5][6], before multiplying and forming colonies that spread along fascial planes to the deeper soft tissue structures [1,6]. It may be confined to the soft tissues for years [4][5][6], but has the potential for imminent osseous changes such as periosteal reaction and cortical erosion that almost always commences from the outside, in contrast to the centrifugal spread typical of bacterial osteomyelitis [1].…”