Figure 2. Left foot of a 6-year-old girl. The first, second, third, and fifth toe are infected with Tunga penetrans. These toes are inflamed, and the second and the third toe are distorted by severe edema. The first toe shows hyperkeratosis. The nails of the first, second, and fifth toe are deformed, and the nail of the third toe is falling off. A flea is trying to penetrate the skin at the edge of the pustule on the medial side of the second toe (11 clockwise). An ulcer has formed above the proximal phalangeal joint of the third toe.