Chief Complaint: “My feet are painful, itchy, and have small sores.”

History of Present Illness:
A 45-year-old man from a coastal fishing village presents to a rural clinic with painful, itchy lesions on his toes and the soles of his feet. The symptoms started about two weeks ago with mild irritation but have worsened over time. He describes a sensation of something embedded in his skin. Some of the lesions have become swollen, and he has difficulty walking comfortably.

He works barefoot on sandy shores and in his small farm near his home. He recalls seeing similar skin issues among other villagers but has never sought treatment before. He denies fever but reports occasional swelling around the affected areas.

Physical Examination:

• Multiple small, round lesions on the toes and soles, some with black central dots
• Mild swelling and redness around the lesions
• A few ulcerated areas with signs of secondary bacterial infection
• No systemic signs of severe infection

Diagnosis:
The clinical presentation is consistent with tungiasis (jigger infestation), caused by Tunga penetrans, a sand flea that burrows into the skin, particularly in individuals who frequently walk barefoot in infested areas.

Management Plan:

• Mechanical removal of embedded fleas using sterile instruments
• Topical and oral antibiotics for secondary bacterial infections
• Wound care with antiseptic cleaning
• Preventive measures:
  • Wearing protective footwear
  • Improving sanitation and reducing contact with flea-infested areas
  • Community education on prevention and early treatment

The patient is advised on proper foot hygiene and scheduled for follow-up to monitor healing and prevent reinfestation.