In this country, it's likely you've never heard of podoconiosis before. Podoconiosis is a disease of the lymph vessels of the lower extremities that is caused by chronic exposure to irritant soils. It is the second most common cause of elephantiasis and is characterized by prominent swelling of the lower extremities, especially the feet and ankles, and leads to disability and deformity.
The history of the condition goes back to the 19th century, when parasitic filariae were discovered to be the cause of elephantiasis, also known as tropical lymphedema. It was believed, at the time, that filaria was the sole cause of the disease, but it became apparent that the distribution of the two conditions did not overlap and scientists recognized that some forms of elephantiasis were not associated with filariae. Ernest W. Price, a British surgeon living in Ethiopia in the 1970's and 1980's studied the lymph nodes and vessels of those afflicted with the disease. Using a light microscope, he discovered macrophage cells weighed down with micro-particles in the lymph nodes of the affected extremity. Then, using an electron microscope, he found the presence of silicon, aluminum, and other soil metals. Price demonstrated that the lymphatic vessels of these patients experienced edema, and eventually collagenization that leads to complete blockage.
The primary symptom of podoconiosis is swelling and deformity of the feet and ankles. The swelling can be either soft and fluid, or hard and fibrotic. Multiple firm nodules will develop over time, as well as hyperkeratotic papillomata that resembles moss. Because of this, podoconiosis is also known as Mossy Foot. Before lymphatic failure, the patient may exhibit itching, burning, hyperkeratosis, plantar edema, and rigid digits. Like with elephantiasis, fusion of the toes, ulceration, and bacterial infection may occur. The disease has an acute component where some patients have moments of foot and ankle warmth, firmness, and pain.
Podoconiosis is most commonly seen in highland areas of Africa, India, and Central America. The highest rates of occurrence are in Uganda, Tanzania, Kenya, Rwanda, Burundi, Sudan, and Ethopia, where the prevalence is as high as 9%. Nearly four million people worldwide suffer from this disease. The incidence of podoconiosis increases with age, due to the cumulative exposure to irritant soil. It is rare to see podoconiosis in children 0-5 years old, and the incidence rapidly rises in the 6-20 age group, with the highest percentage in the 45 plus age group.
Prevention and treatment are characterized by avoidance of the irritant soil . Wearing shoes is the most crucial thing in preventing this disease and further deformity. In Rwanda, where the incidence of the disease is high, the government has banned walking barefoot in public to curtain soil-born disease like podoconiosis.
Even once the disease has begun, vigorous daily washing with soap and water, application of an emollient, and the nightly elevation of the affected extremity has been shown to reduce swelling and disability. Compression wrapping has been shown to be effective in other forms of lymphedema, but this therapy has not been proven in podoconiosis.
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