Podoconiosis: an important but forgotten cause of non-filarial lymphoedema

Abstract

Podoconiosis is a preventable, non-infectious and non-communicable cause of lymphoedema leading to chronic swelling of the foot and lower leg. Most prevalent in Africa, Central America and India, it is caused by long-term exposure to irritant red volcanic clay soil. Risk factors for disease are related to the absence or inadequacy of footwear. However, not all those at risk develop the disease, indicating that both genetic and environmental predispositions contribute to disease development. Symptoms of podoconiosis include asymmetrical limb swelling with associated itching, burning sensation and lymphatic ooze. Late stages are characterised by irreversible swelling and joint fixation. Due to the disfiguring nature of the disease, those affected often experience social stigmatisation. Associated economic losses result from reduced productivity and absenteeism. The disease must be differentiated from conditions such as filarial lymphoedema and congenital lymphoedema, which can have similar presentations, such that appropriate therapy can be implemented. Primary management of podoconiosis is prevention which involves the regular use footwear such as shoes and education of the disease. In the early stages of podoconiosis, compression therapy and limb elevation delays clinical progression in affected individuals. In later stages, changes are irreversible; however, additional therapy can include surgical intervention and limb elevation for symptom control. Psychosocial care is also needed to address the mental distress associated with the disease. Despite the preventable nature of podoconiosis, it remains prevalent in developing countries, necessitating further investment of resources.