Podoconiosis is a non-filarial form of elephantiasis, also called elephant foot disease, not caused by infestation with threadworms. It involves lymphedema caused by the penetration of aluminum, silicate, magnesium, and iron colloids of red laterite soils into the skin with a concomitant genetic predisposition.
What is podoconiosis?
Podoconiosis is a disease common in many tropical countries with red laterite soils, some of which are endemic, and is caused by lymphatic congestion of the feet and legs. Podoconiosis presents with symptoms similar to filarial elephantiasis, which is caused by infection with nematodes (filariae). The main distinction is that podoconiosis is usually bilateral and begins on the feet and slowly rises higher to the knees as the disease progresses, but rarely above. Filarial elephantiasis, on the other hand, is usually unilateral and begins predominantly in the groin region. Podoconiosis occurs predominantly at high altitudes above 1,000 m NHN, whereas mosquito-borne filarial elephantiasis occurs mostly in lowlands below 1,000 m NHN. Podoconiosis is manifested by massive swelling of the feet and legs and usually begins in childhood.
Causes
The main causes of podoconiosis disease are years of walking barefoot on red laterite soil of volcanic origin. Red laterite soil is prevalent in many tropical regions. The dust contains many silicon, aluminum, iron, and magnesium colloids that can penetrate the skin through tiny lesions and be absorbed even through healthy skin. Additional favoring factors are altitudes above 1,000 m NHN and an annual precipitation of more than 1,000 mm. The altitudes and the amounts of precipitation lead to strong temperature fluctuations and promote the washing out and disintegration of the colloids. The particles that penetrate the skin trigger the inflammations and blockages of the lymphatic system that gradually become chronic. In addition to the external factors, there is a genetic disposition as a precondition, so that only a certain part of the population is affected by podoconiosis, even if all other external factors are present. According to current knowledge, the genetic disposition is inherited in an autosomal recessive manner. This means that only individuals in whom both alleles of a particular gene have the defect (homozygosity) can actually develop podoconiosis, even if all other external conditions are present.
Symptoms, complaints, and signs
Incipient podoconiosis initially produces typical symptoms such as burning feet (bilateral) and mild swelling of the middle toes due to the onset of lymphatic congestion in the feet and legs. As the disease progresses, the big toes throb, the feet itch permanently, and fungal and bacterial infections occur on the affected skin areas, which turn grayish due to hyperkeratosis. Often the symptoms are accompanied by strong, unpleasant odor. Edema appears under the soles of the feet, which open and release tissue fluid. In later stages of the disease, lymphedema appears, resulting in severe thickening of the dermis and epidermis, which is either soft to the touch or severely indurated with fibrous tissue. At this stage, the foot and toe joints stiffen extensively and often grow together.
Diagnosis and disease progression
Podoconiosis is a noninfectious disease that occurs in the presence of a number of external conditions and concomitant genetic predisposition. In the early to advanced stages of the disease, it can be stopped by avoiding intense contact of the feet with the triggering particles in the red dust of tropical laterite soils. Differentiation from filarial elephantiasis is already evident in the fact that podoconiosis usually occurs on both feet simultaneously, whereas filarial elephantiasis is almost always unilateral. To be on the safe side, a laboratory examination can provide further information. Podoconiosis causes bulky swelling of the feet and lower legs and fusion of the foot and toe joints with ongoing and intense contact of the feet with the laterite particles.
Complications
Primarily, affected individuals suffer from burning feet due to podoconiosis. Likewise, swelling of the feet occurs in the process, so that movement restrictions also occur.Those affected can no longer move around easily or without pain, so that there are considerable restrictions in the patient’s everyday life. Sometimes the feet also itch, so that there is a significant reduction in the patient’s quality of life. Fungal infections also occur on the feet, which cause additional stress. It is not uncommon for patients to feel ashamed of their complaints and suffer from inferiority complexes or reduced self-esteem. Depression and other psychological upsets can also occur due to the disease. Furthermore, without treatment, stiffening of the joints and toes occurs. Podoconiosis is treated with the help of medications and various therapies. As a rule, no particular complications occur. Surgical procedures may be necessary to treat podoconiosis. The patient’s life expectancy is not negatively affected or reduced by podoconiosis. Furthermore, no other complications occur.
When should you see a doctor?
Burning feet and legs as well as swelling, itching, or bleeding on the legs indicate podoconiosis. A visit to the doctor is necessary if the symptoms do not subside on their own within a week. The condition may also manifest itself as stiff toes, an unpleasant odor and inflammation. If these symptoms occur, the family doctor or a podiatrist must investigate the condition. People who live in poorer regions or rarely wear shoes are particularly at risk. Vacationers who travel in tropical regions or highland areas with moist soil and heavy rainfall also contract podoconiosis and should see their family doctor after returning from their destination. Other points of contact are the dermatologist or an orthopedist. If the disease has already spread to the vessels, a specialist in internal medicine must also be involved in the treatment of podoconiosis. The therapy is uncomplicated and does not require strict medical supervision if the symptoms are mild. In cases of severe inflammation and skin lesions, further surgical intervention may be needed, which requires good preoperative and postoperative care by the physician and patient.
Treatment and therapy
Treatment of podoconiosis depends on the stage of the disease and, in principle, consists of stopping further uptake of the lymphatic system reactions that trigger the inflammations and trying to eliminate the lymphatic congestion. Secondary infections are treated in parallel. Therefore, concrete measures such as wearing socks and high and sturdy shoes, as well as observing basic hygiene, which consists of washing the feet with soap every day, are effective. Great success has been achieved when affected persons, who mostly work in agriculture, could be retrained to other trades in order to avoid further intensive contact of the feet and legs with the laterite dust. Other treatment measures include the regular application of skin creams to prevent the harmful particles from penetrating the skin. Elevation of the legs, as well as regular application of compression techniques and the use of lymphatic drainage, can also lead to significant improvements in symptoms. In selected cases, surgical intervention may be necessary to remove nodules and hyperplasia.
Prevention
The most effective preventive measure to avoid podoconiosis is to protect the feet and legs from ongoing intense contact with red laterite dust. Those at risk should wear socks and sturdy shoes, as well as wash their feet daily with soap and water and apply skin creams regularly. Even better prevention is to choose an occupation that does not put feet and legs in intense contact with the laterite dust.
Aftercare
In most cases, the person affected by podoconiosis has very few or limited options for aftercare. With this disease, a doctor should be consulted in the first place quickly and above all very early, so that it does not come in the further course to further complications or to a further worsening of the symptoms. In the worst case, death of the affected person may occur if the disease is not treated properly. Since podoconiosis can also occur due to genetic causes, the affected person should undergo genetic testing and counseling if he or she wishes to have children.Sufferers should wear light and open-toed footwear to alleviate the discomfort. Wearing socks also has a positive effect on the further course of the disease. In some cases, however, even a surgical intervention is necessary to permanently alleviate the discomfort of podoconiosis. The affected person should rest and take care of his body after such an operation. Stressful or physical activities should be avoided. If podoconiosis is treated properly and in time, there is usually no reduced life expectancy of the affected person.
What you can do yourself
Podoconiosis can be prevented with simple self-help measures. Anyone living in one of the high-risk areas should wear closed-toe shoes and avoid contact with people with the disease. In addition, feet should be washed several times a day to prevent pathogens from remaining on the skin. If elephantiasis has already formed, the sufferer must consult a doctor. Accompanying the medical treatment, various ointments and lotions from natural medicine can be used. Preparations with aloe vera or devil’s claw, but also classic infusions of chamomile tea or black tea have proven themselves. In addition, the feet must be carefully cleaned. Especially the affected areas on the heels and toes must be washed in the morning and evening and treated with the care products suggested by the doctor. It is important to avoid possibly stressful surfaces and to wear sturdy footwear. In cases of severe disease, special shoes must be worn, as the swollen foot will not fit into classic sneakers or sandals. To avoid infection, partners should initially sleep in separate beds. If, despite these measures, the symptoms intensify, it is best to inform the doctor.
