A possible Madura foot from medieval Estremoz, southern Portugal

Maduromycosis, commonly called Madura foot, is an infectious pathology caused by fungi or bacteria, and it is native of the tropical, subtropical and equatorial areas. This paper presents a well preserved male skeleton, between 23 and 57 years old from a medieval necropolis (13th-15th centuries) in Estremoz, Portugal.The left foot of this individual showed marked alterations on the morphology of the calcaneus and cuboid that are ankylosed, which led to arthrosis of the calcaneous and talus. The five metatarsals have bone destruction and irregular subperiosteal new bone formation with multiple lytic foci and progressive osteoporosis with very little reactive bone formation. After a careful differential diagnosis, taking into consideration various pathological conditions,it was concluded that this is a possible case of maduromycosis.This study suggests that in the past this pathology could have been present in Europe, particularly in the Mediterranean region, and especially when the climatic conditions were conducive.This could be one of the first cases of maduromycosis infection published in an archaeological context.