An Illustrative Report of Three Cases of Madura Foot with Diagnostic and Treatment Features

INTRODUCTION: Madura foot is a rare infective granulomatous foot disease. The burden of this disease has significantly declined in recent years due to better generalized living conditions. Hence, the diagnosis can be quite often missed by the new generation orthopedic surgeon for other more similar conditions. Early diagnosis and prompt treatment is crucial for better outcome and limb survival. We here present the clinical picture of three such Madura foot cases. CASE SERIES: In this study, three Indian males aged between 40 and 60 years of rural background presented to our department with chronic multiple discharging sinuses of the foot. They were initially treated for several months in their local health centers without any improvement. Finally, they came to our institution where they were thoroughly inspected and underwent various investigations such as magnetic resonance imaging (MRI) and histopathological examination. They were referred across various departments such as dermatology, general surgery and orthopedics, and eventually got correct diagnosis. Treatment was promptly started with oral itraconazole, an antifungal drug, and one patient undergoing additional surgical debulking of the disease which lead to gradual healing of the disease as evident by disappearance of sinuses and return of normal skin in 6-12 months. CONCLUSION: Madura foot is very characteristic, although it may mimic more prevalent infectious conditions. The characteristic multiple discharging sinuses with extrusions of sulphur granules and MRI findings of “dot in circle” should clinch the diagnosis quickly. Medical therapy should be continued for at least 12 months even if there is resolution of disease in the early or mid-phase of treatment. Debulking of the disease will aid in early recovery and reduce abnormal swelling or appearance of the foot.