MADURA FOOT- as differential diagnosis of the chronic wounds on the foot

Javorka Delic,

Angiology Department,

Belgrade, Serbia

Spasoje Radovanovic, Dermatology department,

Francistown, Bocwana

8% CWs localised on the foot

During 2012. years in Angiology Department were 5231 chronic wounds different etiology (retrospective study)

Of them 403 (8%) were localised on the foot, at men in 283 cases

Paralel localisation on the foot et limb were in 52 (12,5%) of all cases

Etiology of the wounds

Pressure wounds 121 (35%)

Veins wounds 97 (24.5%)

Mixtum art.veins 12 (3%)

Arterial wounds 72 (18%)

Postopetrative 12 ( 3%)

Etilogy of the wounds

Posttraumatic w. 9 ( 2,3%)

Jatrogenes w. 3 (0,5%)

Diabetic wounds 28 ( 4,5%)

Infective wounds 7 ( 2%)

Etiology of the wounds

Vasculitis wounds -16 (4%)

Others 3,5%

Paralel wounds on the leg and the foot on 52( 12 ,5%)

Wounds and ages

There was two group

older - 67 years average ,with pressure,veins and arterial wounds

Yanger- 34.5 years average

with vasculitis, infective, posttraumatic wounds

Wounds on the leg (paralel exam)

Exam the distribution chronic wounds on the leg

The most frequent wounda was - veins wounds

In 65% off all cases

All wounds other etiology -from 0,5% to 17%

Madura foot

Madura foot is a cause of the wounds on the foot

Specific and rare differential diagnosis ,presenting clinical with the tumefaction, oedema ,

inflammation ,multiple fistulaes and specific scars and anatomic

derformation of the foot .

Etiology of Madura foot

The disease is decribed, first time Gill , 1842, in Madura, endemic area in India

Etiologically can be Eumycetoma, is evoced by pathogen fungi or Actinomycetoma, and infected by bacteries ( Actinomycetom) on place on the skin thrauma.

Diagnosis

The diagnosis is determined by :

Clinical signs ; chronic wounds, many cicatrix , swelling and inflammation on the foot

Microbiological exam: Colored “Grains” in exudate-the groups of the causes;

Diagnosis

Hystological exam – Gram positive finding of gram negative grannulas, with eosinophilic deposits about them (Splendore-Hoeppli reaction);

Rendgen exam of the bones- disturbes of the bones, cavities fulfilled by groups of causes and thinned of bone mass.

The treatment

The treatment is consisted of by antibiotics, antimycotics and coricosteroides, five weeks ,more repeated sessions and very often in Africa

by operation (amputation).

The wounds were chronic , more months or often, more years.

Differential diagnosis

Madura foot is infective, non –vascular chronic wounds , in endemic areas and could be one differential diagnosis of CWs on the foot at patients with more small wounds, mycosis of the skin, osteomyelitis, vasculitis, lymphoedema , immunodefitienty and malnutrition.

Conclusion

Chronic wounds on foot presenting 8% of all CWS on the legs, which were most frequentlly arterial, pressure ,postthraumatic and mixtum wounds.

Madura foot could be in differential diagnosis of the CWs localised on the foot

Greeting from Bocwana !

Greeting from Belgrade !

Thank you!

Prim Dr Javorka Delic

drdelc@orion.rs

President of Serbian Wound Healing Society