What is Podoconiosis?

Podoconiosis, meaning “dusty feet,” is a non-infectious tropical disease caused by the exposure of bare feet to irritant alkalic clay soils. Also known as non-filarial elephantiasis, podoconiosis is a chronic condition that causes an asymmetrical swelling of the feet and lower limbs due to lymphedema (for more on lymphedema, see below). This swelling is called “elephantiasis” and may lead to severe disability of the patient. Symptoms may include severe fatigue, a heavy swollen limb or localized fluid accumulation in other body areas, including the head or neck, discoloration of the skin overlying the lymphedema, and eventually deformity caused by extreme swelling and fluid retention (elephantiasis).

Podoconiosis affects 4 million people worldwide, and it is endemic in areas of tropical Africa, Central and South America and northwest India. In the Northern Province of Rwanda, the contraction of podoconiosis is caused by high concentrations of silica found in the volcanic soil originating from the Virunga mountains. Many with podoconiosis in this region are subsistence farmers with high levels of exposure to the silica while working barefooted in the fields.

There is currently no up-to-date data about Podoconiosis in Rwanda, but a study entitled “Endemic Elephantiasis of the Lower legs in Rwanda and Burundi” conducted by Tropical and Geological Medicine in 1975, reported a prevalence of 7.10 per 1000 of lower legs elephantiasis in areas in Rwanda where alkali clay soils coexist with high altitude, high seasonal rainfall and low income. Footwork, the International Podoconiosis Initiative, is currently embarking on a research project that will map podoconiosis patients throughout Rwanda.

A General Overview on Lymphedema

Lymphedema, also known as lymphatic obstruction, is characterized by localized fluid retention and edema due to a compromised lymphatic system. The resulting asymmetrical tissue swelling and restricted blood flow often lead to discomfort and pain. This chronic and progressive condition gives rise to a range of secondary complications including musculoskeletal disorders due to asymmetrical edema, papillomatosis due to hyperplasia, hyperkeratosis, and fibrosis and skin infections due to skin breakage.

Lymphedema can be classified into four different stages:

Stage 0 is known as the “latent” stage where lymphatic vessels have undergone an amount of damage that has left the lymphatic system capable of stille transporting and removing lymphatic fluid. At stage 0, the lymphatic damage is not considered to have induced lymphedema.

Stage 1 is referred to as the “spontaneously reversible” stage because affected tissues still retain their elasticity and are “non-pitting” in that they do not display indentation when pressed. Those with stage 1 lymphedema will often find that affected tissues are normal or near normal in size in the morning.

Stage 2 is referred to as the “spontaneously irreversible” stage at which affected tissues possess a spongy consistency and are “pitting” in that indentations are sustained when pressed. Significant increases in limb size and skin growth may begin with the development of fibrosis in stage 2.

Stage 3 is commonly known as the “lymphostatic elephantiasis” or simply “elephantiasis.” By stage 3, affected tissues are fibrotic and unresponsive and give rise to greatly enlarged limbs. At this point, swelling is usually irreversible.

Lymphedema treatment usually consists of a physician or certified lymphedema therapist-instructed daily regimen of treatment that differs based on the severity of tissue swelling and hardening.

Lymphedema treatment usually consists of a daily regimen of various treatments usually instructed by a physician or certified lymphedema therapist. Lymphedema treatment regimens differ based on the severity of tissue swelling and hardening and can commonly be combinations of compression bandaging or garments, manual compression, lymphatic massage, and skin care. These treatment procedures can also be performed individually depending on the patient’s situation.