I did a search on Medline using the search term "Madura
mycosis" This yeilded 74 citations most of which were on the subject. One of the most
recent was published in Acta Belgica Orthopaedica in 1998 and was typical of the abstracts
I read, stressing the need for a mycological diagnosis and aggressive antibiotic
treatment.
Acta Orthop Belg 1998 Jun;64(2):242-8
The Madura foot: an "innocent foot mycosis"?
Ten Broeke R, Walenkamp G
Department of Orthopedic Surgery, University Hospital Maastricht, TheNetherlands.
With the increased movement of the world population, acquaintance with the clinical
picture of the Madura foot is of growing importance beyond its original endemic areas. The
characteristic triad of symptoms consists of indurated swelling, multiple sinus tracts
with purulent discharge filled with grains and localization at the foot. An increasing
number of new etiologic agents are recognized today. For a better choice of therapy an
adequate diagnostic procedure is essential ; a deep biopsy for histology appears to give a
more substantial contribution to identification of the causal organism than culture. The
treatment which should be started early, is at first essentially a drug treatment.
However, in spite of high expectations with regard to new antimycotic drugs, amputation or
disarticulation is often inevitable even today, particularly when the lesion is caused by
Eumycetes. The first two documented patients with this disease in the Netherlands are
described. They developed serious deformities of the lower extremity despite long-term use
of antimycotic and antibiotic medication.
The list of citations in the "related articles" is longer, not so specific
but quite comprehensive. Its address is
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Link&db=PubMed&dbFrom=PubMed&from_uid=9689768
Myles Clough mylesclough@shaw.ca
Orthopaedic Surgeon, Kamloops, BC, Canada
Maduramycosis is indeed rare everywhere. Treatment is controversial as pharmacotherapy
doesn't seem to have much effect. Dapsone & Tetracyclines are two recommended drugs.
However, the foot lesion is very recalcitrant and most often ends up in a Syme's
amputation.
The danger of inadequate local clearance - just in case you were planning a curettage - is
that there may be a systemic spread especially the inguinal nodes and intestines.
All the best,
Dr. T.M. Sunil, M.B.,B.S.(B.M.C.), M.S. ORTH (MADRAS), D.N.B. ORTH
ASSISTANT PROFESSOR
DEPT. OF ORTHOPAEDICS
M.S. RAMAIAH MEDICAL COLLEGE
BANGALORE
INDIA
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