ewma 2013 - ep524 - madura foot- as differential diagnosis of the chronic wounds on the foot
DESCRIPTION
Javorka Delic, Angiology Department, Belgrade, Serbia Spasoje Radovanovic, Dermatology department, Francistown, BocwanaTRANSCRIPT
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
President of Serbian Wound Healing Society