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Fig. 6.23 A-E The pattern of development of madura foot demonstrated by examples of the true fungus Madurella mycetomi group. A A fungal granuloma on the sole of the foot, superficial to the ligaments. This will stay localized for a long period but can grow to a large size and resemble a tumor. B This large fungal mass of Madurella mycetomi is deep to the plantar ligament. The bone has not been affected. C Madurella infection can be localized, involving the soft tissue as well as the bone, which has been molded. There are large circular cavities in the phalanges, surrounded by a dense sclerotic reaction: this usually indicates a secondary infection. There are well-defined periosteal buttresses. D An unusual Madurella infection in the upper end of the tibia with multiple large defects and only minimal bone reaction. E The marked spiculated reaction of Streptomyces somaliensis with numerous underlying lucent defects: the lower end of the tibia with some minimal reaction around the fibula. F A more extensive S. somaliensis reaction affecting soft tissues and bones of the lateral aspect of the foot. (F courtesy of Professor Harold Jacobson)



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Fig. 6.24 A-F The radiographic appearances of Madura foot may be typical of a fungal infection, but it is not always possible to identify the fungus. A Marked nodular soft tissue reaction, with destruction of the second metatarsal. This could be mistaken for Kaposi sarcoma, but such advanced involvement of one metatarsal only would be unusual. B Soft tissue edema and fungal infection of all the metatarsals, most of the tarsal bones and the proximal digit of the first toe. C A more advanced infection, with destruction of the tarsus and the proximal end of the metatarsal. D Another patient with tarsal infection, soft tissue swelling, and joint involvement. E Multiple lytic areas in the os calcis with periosteal reaction and early cortical defects. There are some early foci in other tarsal bones. F A more advanced infection, with soft tissue swelling and partial destruction of the os calcis, the tallus, and other tarsal bones. (A, C, E courtesy of Professor Harold Jacobson)


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