An approach to histology-based diagnosis and treatment of Madura foot.

Madura foot is a deep mycosis commonly seen in tropical and subtropical countries such as India. Its incidence is likely to rise in temperate regions as well, due to the increase in worldwide travel. The cases presented here are all agricultural workers from a rural part of northern India who had induration, fibrosis and minimal discharge from sinuses over the foot. Although culture remains the gold standard diagnostic test, this case report highlights the importance of histopathology in the early diagnosis and differentiation of common causative agents in Madura foot as repeated cultures are sometimes negative. Thus for mycetomas in which causative infectious agents cannot be isolated, histology may prove beneficial by avoiding inadvertent use of combined antifungal and antimicrobial agents so that a correct therapeutic modality can be decided, prognostic outcome be explained to the patient, and a preventable cause of deformity and disability can be identified and treated at an early stage.