Introduction. Critical limb ischemia (CLI) is the reduced blood flow in the arteries of the lower extremities. It is a serious form of peripheral arterial disease, or PAD. If left untreated the complications of CLI will result in amputation of affected limb. The treatment experience of diabetic foot with transverse tibial transport was carried out by Ilizarov technique. Madura foot ulcer is not a common condition. It disturbs the daily activities of the patient. Pain swelling with multiple nodules with discharging sinus with discoloration(blackening) of the affected area is the main problem. Materials and Methods. We treated total case: 36 from Jan. 2003 – Jan. 2020 (17yrs.). Among these-. TAO- 20. Limb Ishchemia- 5. Diabetic Foot- 9. Mycetoma pedis- 2. Infected sole and dorsum of the foot- 5. Results. Transverse corticotomy and wire technique followed by distraction increases blood circulation of the lower limbs, relieving the pain. The cases reported here were posted for amputation by the vascular surgeons, who did not have any other option for treatment. Hence we, re-affirm that Academician Prof. Ilizarov's method of treatment does help some patients suffering from these diseases. Conclusions. By Ilizarov compression distraction device for TAO, modura foot ulcer, diabetic foot ulcer, mycetoma pedis ulcer, infected sole and dorsum of the foot ulcer were treated by introducing K/wires through the bones with proper vertical corticotomy. Application of this noble device will bring angeogenesis within the reach of all deserving patients

This article presents an overview of mycetoma and offers guidelines for orthopaedic surgeons who may be involved in the care of patients with this condition.

Cite this article: Bone Joint J 2014;96-B:420–5.

Purpose of the study: Mycetoma designates an inflammatory pseudotumour caused by fungal or bacterial agents with a slow chronic course and characterised by the emission of species-specific grains through fistules. Like the foot, the knee is a weight-bearing zone which can lead to mycetoma of soft tissue and/or bone or articular tissue. The purpose of this work was to study the frequency of the different clinical forms and report medical and surgical outcomes of the localisation. Material and methods: This was a retrospective analysis of consecutive files collected over a 20-year period from July 1988 to 2008 including a total of 267 cases. Twentyfive patients (22 male 3 female) had an articular or peri-articular mycetoma of the knee joint. Mean age was 31.8 years (range 18–59). The right knee was involved in 17 cases and the left in eight. Duration of symptoms was 2.2 years (range 1–25 years). Antibacterial treatment with sulfamethoxazole and exclusively for actinomycetoma was given for 10 months at least and antifungal treatment with ketoconazole as adjuvant treatment with surgery for maduromycetomas. This orthopaedic surgery was radical (three above-knee amputations) or conservative (directed healing for 5, first-intention surgery for 5 with a flap for 3 and with a graft for the others). Results: The knee accounted for 9.23% of the localizations in our series, most common after the foot and ankle. Twenty cases were exclusively maduromycetomas with black grains; the five others were actinomycetomas: 3 red grain, 1 white grain and 1 yellow grain. The topographic forms were predominantly anterior localization: 15 cases (versus popliteal in two, the entire knee in four and unknown in four). According to the Bouffard classification, the lesions were: diffuse (n=20), polyfisutulised (n=20), sclerohypertrophic (n=1) versus two localized encapsulated forms. Local spread led to bone and joint involvement in six patients, mycosis arthritis in three complicated by a pathological fracture of the patella. At last follow-up, there have been three recurrences with limited flexion in four patients. Discussion: Articular or extra-articular mycetoma of the knee is an infectious dermato-orthopaedic disease dominated by fungal infection. Treatment is particularly difficult in advanced stage disease, medical and surgical management can be proposed with cancerological type resection

Purpose: Mycetomas are progressive pseudotumours affecting the skin, soft tissue or bone caused by bacterial or fungal infection. Although the foot and ankle are often affected and considered together, mycetoma of the ankle should be considered as a separate nosological entity. The purpose of this work was to study the frequency of primary mycetoma of the ankle and describe the different anatomicoclinical variants and prognostic factors. Material and methods: Thirty-five cases of primary mycetoma of the ankle were reviewed retrospectively. This series was selected from a total of 141 mycetomas treated between July 1998 and November 2110. There were 22 men and 13 women. The patients were farmers or cattle raisers, mostly belonging to the toucoulour and peulh ethnic groups. Mean duration of the mycetoma was six months (nine months – twenty years). The right ankle was involved in 21 cases and the left in 12, the side was not noted in two cases. A fungal cause was identified in 25 cases [black grain = 24 (Madurella mycetomatis = 8, Leptospheria senegalensis = 6, unidentified = 11) and white grain = 1 (Pseudoallescheria boydii)]. Actinomycosal infection was identified in six cases [red grain = 2 (Actinomadura pelletieri), white grain = 4 (Actinomadura madurae) and yellow grain = 1 (Streptomyces somaliensis)]. The causal agent was unidentified in four cases. Sixteen patients underwent surgical treatment, surgical treatments were scheduled for four patients, and four were treated medically. Results: Primary mycetoma affected the ankle in 16.3% of the cases. The presence of a benign encapsulatd (37.5%) often uniretromalleolar or biretromalleolar nodule was characteristic of the fungal form. A diffuse polyfistulated (41.6%) and premalleolar form which eventually covered the entire ankle was also noted. Secondary bone infection led to osteitis and or osteoarthrtis in 54.1% of the cases. Mycetomic osteitis required amputation in 5 patients (20.8%). We noted one case of recurrence among our direct admissions and five cases among referrals. Conclusion: Mycetoma of the ankle should be distinguished from mycetoma of the foot. The benign encapuslated fungal form is situated behind the malleolus and can be distinguished from the diffuse polyfistulated osteophilic actinomycosic or fungal form that covers the entire ankle

1. Twenty cases of mycetoma pedis are described. 2. Most patients had the disease in an early stage and were cured by simple excision. 3. The importance of early diagnosis and treatment in order to avoid amputation is emphasised