Podokoniosis is a non- filarial form of elephantiasis, also known as elephant foot disease, i.e. it is not caused by infestation with roundworms. It is a case of lymphedema caused by the penetration of aluminium, silicate, magnesium and iron colloids from red laterite soils into the skin with a simultaneous genetic disposition.
What is podoconiosis?
Podokoniosis is a disease that is endemic in many tropical countries with red laterite soils and is caused by lymphatic congestion in the feet and legs. Podokoniosis shows symptoms similar to filarious elephantiasis, which is caused by an infection with roundworms (filariae). The main distinction is that podoconiosis is most commonly bilateral, beginning on the feet and slowly progressing to the knees as the disease progresses, but rarely above. See polyhobbies for Meanings of Hangover (or Alcohol Intoxication).
Filarian elephantiasis, on the other hand, is usually unilateral and begins primarily in the groin region. Podokoniosis mainly occurs at high altitudes of over 1,000 m above sea level, while mosquito-transmitted filarious elephantiasis mostly occurs in the lowlands below 1,000 m above sea level. Podokoniosis is manifested by massive swellings on the feet and legs and usually begins in childhood.
The main cause of contracting podoconiosis is years of walking barefoot on red laterite soil of volcanic origin. The red laterite soil is predominant in many tropical regions. The dust contains many colloids of silicon, aluminium, iron and magnesium, which penetrate the skin through tiny injuries and can even be absorbed through healthy skin.
Additional favorable factors are altitudes of over 1,000 m NHN and annual precipitation of over 1,000 mm. The altitude and the amount of precipitation lead to strong temperature fluctuations and promote the leaching and decomposition of the colloids. The particles that have penetrated the skin trigger the inflammation and blockages in the lymphatic system that gradually become chronic.
In addition to the external factors, there is also a genetic disposition as a prerequisite, 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 people in whom both alleles of a specific gene have the defect (homozygosity) can actually develop podoconiosis if all other external conditions are present.
Symptoms, Ailments & Signs
The onset of podoconiosis initially produces typical symptoms such as burning feet (both sides) and slight 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 constantly and there are fungal and bacterial infections on the affected skin areas, which turn greyish due to hyperkeratosis.
The symptoms are often accompanied by a strong, unpleasant odor. Edema appears under the soles of the feet, which open and release tissue fluid. In later stages of the disease, lymphedema is evident, resulting in severe thickening of the dermis and epidermis, either soft to the touch or severely indurated and interspersed with fibrous tissue. At this stage, the foot and toe joints become largely stiff and often grow together.
Diagnosis & course of disease
Podokoniosis is a non-infectious disease that occurs in the presence of a number of external conditions and a simultaneous genetic disposition. In the early to advanced stages of the disease, it can be stopped by avoiding intense foot contact with the initiating particles in the red dust of tropical laterite soils.
A distinction from filarious elephantiasis is already evident in the fact that podoconiosis usually occurs on both feet at the same time, while filarious elephantiasis is almost always unilateral. To be on the safe side, a laboratory test can provide further information. With continuous and intensive contact of the feet with the laterite particles, podoconiosis leads to misshapen swellings on the feet and lower legs and to the ankles and toes growing together.
First and foremost, those affected suffer from burning feet due to podoconiosis. Swelling of the feet also occurs, so that movement restrictions also occur. Those affected can no longer move easily and also no longer without pain, so that there are considerable restrictions in the patient’s everyday life. Sometimes the feet also itch, resulting in a significant reduction in the patient’s quality of life.
Fungal diseases also occur on the feet, which are an additional burden. Patients are often ashamed of the symptoms and suffer from inferiority complexes or low self-esteem. Depression and other psychological upsets can also occur as a result of the disease. Furthermore, if left untreated, the joints and toes will become stiff.
Treatment of podoconiosis is carried out with the help of drugs and various therapies. Usually there are no special complications. Surgery may be necessary to treat podoconiosis. The patient’s life expectancy is not negatively affected or reduced by podoconiosis. Furthermore, there are no further complications.
When should you go to the doctor?
Burning feet and legs as well as swelling, itching or bleeding in the legs indicate podoconiosis. A doctor’s visit is necessary if the symptoms do not go away on their own within a week. The condition can also manifest itself through stiff toes, an unpleasant odor and inflammation. When these symptoms appear, the general practitioner or a podiatrist needs to evaluate the condition. People who live in poorer regions or who rarely wear shoes are particularly at risk.
Holidaymakers who travel to tropical regions or highland regions with damp soil and heavy rainfall also fall ill with podoconiosis and should see their family doctor after returning from the travel country. Other contact points are the dermatologist or an orthopaedist.
In addition, if the disease has already spread to the vessels, a specialist in internal medicine must be involved in the treatment of podoconiosis. The therapy is uncomplicated and does not have to be strictly monitored by a doctor if the symptoms are weak. In the case of severe inflammation and skin injuries, further surgical interventions may be necessary, which require good pre- and post-operative care by the doctor and patient.
Treatment & Therapy
The treatment of podoconiosis depends on the stage of the disease and basically consists of stopping the further uptake of the inflammatory reactions of the lymphatic system and trying to eliminate the lymphatic congestion. In parallel, secondary infections are treated. Concrete measures such as wearing socks and high and sturdy shoes as well as observing basic hygiene, which consists of washing feet with soap every day, are effective.
Great success was achieved when those affected, who mostly worked in agriculture, could be retrained in other trades to avoid further intensive contact of their feet and legs with the laterite dust. Further treatment measures consist of the regular use of skin creams that prevent the harmful particles from penetrating the skin.
Elevating the legs as well as regular use 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.
The most effective preventive measure to avoid podoconiosis is to protect the feet and legs from continuous intense contact with the red laterite dust. Those at risk should wear socks and sturdy shoes, wash their feet daily with soap and water, and apply skin creams regularly. Even better prevention is to choose a job that doesn’t put your feet and legs in intense contact with the laterite dust.
In most cases, those affected with podoconiosis have very few or limited options for aftercare. In the case of this disease, a doctor should first and foremost be consulted quickly and, above all, very early on, so that further complications or a further deterioration of the symptoms do not occur in the further course.
In the worst case, the patient dies if the disease is not treated properly. Since podoconiosis can also occur due to genetic causes, the affected person should carry out a genetic examination and counseling if they wish to have children. Those affected should wear light and open-toed shoes to relieve the symptoms.
Wearing socks also has a positive effect on the further course of the disease. In some cases, however, surgery is even necessary to permanently relieve the symptoms of podoconiosis. The affected person should rest after such an operation and take care of his body. Stressful or physical activities should be avoided. If podoconiosis is treated correctly and in good time, the life expectancy of the affected person is usually not reduced.
You can do that yourself
Podokoniosis can be avoided with simple self-help measures. Anyone who lives in one of the risk areas should wear closed shoes and avoid contact with sick people. In addition, the feet should be washed several times a day so that no pathogens remain on the skin.
If elephantiasis has already formed, the patient must consult a doctor. Various ointments and lotions from naturopathy can be used to accompany the drug treatment. Preparations with aloe vera or devil’s claw have proven their worth, as have classic infusions of chamomile tea or black tea. In addition, the feet must be carefully cleaned. In particular, the affected areas on the heels and toes must be washed morning and evening and treated with the care products recommended by the doctor. It is important to avoid potentially loaded surfaces and to wear sturdy shoes.
In the case of serious illnesses, special shoes must be worn, since the swollen foot does not fit into classic sneakers or sandals. To avoid infection, partners should initially sleep in separate beds. If, despite these measures, the symptoms worsen, it is best to inform the doctor.