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December 17, 1982

Massive Swelling of the Foot in a 63-Year-Old Man

JAMA. 1982;248(23):3173-3174. doi:10.1001/jama.1982.03330230071039

History  A 63-year-old nondiabetic man residing in a nursing home experienced painless massive nodular swellings of the left ankle and foot during a period of several months. Ulceration, draining sinus tracts, and foul-smelling discharge developed in the foot. The patient was treated with multiple antibiotics, external medication, and dressing, without improvement. The patient was ill-nourished on examination and demonstrated an organic brain syndrome. Physical examination results were otherwise normal. Investigations included a complete blood cell count, ESR, and chest roentgenogram, all of which gave normal results. Roentgenograms of the foot (Figs 1 and 2) were obtained.

Diagnosis  Madura foot.

Comment  An anteroposterior view of the foot with soft-tissue technique (Fig 1) and a well-penetrated roentgenogram (Fig 2) demonstrate diffuse, lobulated, nodular soft-tissue swellings enveloping the foot. Calcification is absent in the soft-tissue nodules. The underlying osseous structures do not show any erosion, reactive new bone, periosteal reaction, or osteomyelitis. The