A painful, swelling and discharging sinus in the right foot

A 45-year-old male adult, a farmer by occupation from a small village in the Sub-Himalayan region of North India presented with a history of pain, swelling and discharging sinus in the right foot for the previous 5–6 years. Initially, the lesion was a single nodular swelling followed by multiple nodular thickenings and discharging sinuses. He took analgesics and antibiotics from a local physician and was partially relieved but the disease process continued. The patient presented to our hospital for further management. On examination the foot showed swelling and a hardened surface with multiple discharging sinuses. The discharge was slightly blackish in appearance (Figure 1)