A 19 year old male farmer from rural area in Sudan presented to our clinic at Omdurman Hospital –Sudan, complaining of chronic ankle pain, swelling and abscess formation for one year, it started with small painless swelling that gradually increasing in size, over period of time his life style had been affected by increasing pain intensity, walking difficulties and inactivity, symptoms became more severe when limited restriction of movement involved the subtalar joint. Sinus formation with purulent pale discharge and black grains were noted. Initially and without proper assessment, he was diagnosed with cellulitis and abscess formation, thus he was treated accordingly by incision and drainage. No biopsies or swabs had been taken for culture and sensitivity. Post-operative course oral antibiotic has been prescribed for 7 days. Since then the deterioration in his general condition had been growing steadily. Painful limping, swelling and limitation of movement on the affected side had been worsening dramatically. Furthermore he ended by using crutches. On clinical examination there was obvious ankle swelling and tenderness mainly at the lateral side of the hind foot, single sinus with active greenish discharge was identified [Fig. ]. Hematological investigations were unremarkable, X-ray revealed calcaneus scalloping lesion forming 2 cavities posterior to the posterior facet of the calcaneus consistent with chronic osteomyelitis [Figs., ]. Surgical debridement under spinal anesthesia and tourniquet was employed in lateral decubitus position with lateral extensile calcaneus approach. Debridement was done and the 2 cavities were cleaned with aggressive curettage, the black grains consist of eumycetoma were confirmed by histopathology [Fig. ]. Hence, Itraconazole 400 mg daily for at least 1 year was prescribed. Six months follow up as it shown in the Table below: