The Bone Changes of Madura Foot

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Abstract
Mycetoma pedis or Madura foot is the name used to indicate a clinical entity resulting from invasion of the foot, and occasionally other parts of the body, by a filamentous fungus. It is thought that the fungus is usually introduced by the prick of an infected thorn or splinter. It is characteristic of the disease that bodies of various shapes, resembling small grains which are, in fact, clumps of fungi, should be found either in the discharge from the affected area or in a biopsy specimen (Abbott, 1956). Although mycetoma pedis has a wide distribution throughout the tropics and subtropics, comparatively few descriptions of its radiological features have appeared in the English literature (Pagenstecher, 1922; Grantham-Hill, 1931; Jones and Alden, 1931; Carroll, 1949). The present paper will describe the main radiological findings in 21 cases among Uganda Africans admitted to Mulago Hospital, Kampala, during the last five years. Clinical and Pathological Pictures As would be expected, the disease is almost wholly confined to barefooted cultivators. It is commoner among men (16 men to 5 women in this series), but while this may reflect the lessened exposure risk of women in some countries, in Uganda, where much of the cultivation is done by women, it is in keeping with the relative hospital admission rate of the two sexes. It is probably a coincidence that among the Mulago patients the right foot should be twice as commonly involved as the left. No age is immune, but the disease is usually found among those in the active years of life; in the present series, the average estimated age was forty-six, and the youngest patient was twenty-eight years old. The duration of the disease before the patient seeks medical aid varies enormously, for while some will come to the hospital within a few months of the onset of symptoms, the majority do not report for two or three years. One patient in the present series waited for eight years, and another for five years. This wide variation is probably related to the degree of pain suffered, for although a few complain of “pins and needles” or a throbbing sensation of varying severity, the majority experience little discomfort. Only 3 of the Mulago patients complained of severe pain. The clinical course of the disease has been described in detail by Abbott (1956), who collected reports of 1,231 cases from Sudan hospitals during a period of two and a half years. He classifies his cases, according to the color of the fungus grains, into yellow, black, and red mycetoma. He states that there is first a painless swelling of the affected part, and that, while in yellow mycetoma this swelling has ill-defined margins and involves only the skin and subcutaneous tissues, in black mycetoma it takes the form of a clearly defined, hardish, painless nodule in the subcutaneous tissues.

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