This case demonstrates fairly typical appearances of advanced Madura foot (maduromycosis) of three years duration. 

Maduramycosis is a chronic granulomatous fungal disease affecting lower limbs especially the foot. The disease is caused by the filamentous fungi which when introduced into the human body by prick of infected thorn or splinter. Typical clinical findings of the disease help to make a diagnosis which includes, painless wound involving the part of a limb with multiple discharging sinuses for a long time, having yellow colored discharge resembling small grains which are, in fact, clumps of fungi (also found in biopsy).

Furthermore, as these fastidious organisms sometimes are difficult to demonstrate either on biopsy or microbiological culture, or when the clinical and biopsy findings are equivocal, MRI scan helps to make the diagnosis.

The recently described "Dot in circle sign" is the characteristic for Madura foot.