domingo, 20 de marzo de 2022



March is "World Lymphatic Vascular Disease Awareness Month" which includes Podoconiosis, as a disease related to Lymphatic dysfunction. Podoconiosis Awareness Month aims to raise awareness about Podoconiosis, a disease that affects the Lymphatic Vascular System, and teach people that this disease is easily treatable today. Many people in endemic countries continue to suffer from this disease due to a lack of access to basic medical care. 

Podoconiosis disease is most prevalent in resource-limited countries in Africa and especially agrarian people who work barefoot, particularly in the neighborhood of volcanoes. Tiny microparticles of silica from the volcanic soil and aluminosilicates penetrate the skin, causing lymphatic obstruction. The end result sometimes referred to as “Mossy Foot Disease” or “Bigfoot Disease, is subsequent chronic lymphatic edema.

Podoconiosis almost always affects the lower limbs and especially the feet, it is a non-filarial, noninfective disease, and is usually caused by crystalline blockage of the lymphatics(Lymphatic Circulatory System). Most Podoconiosis first becomes symptomatic in the early teens and affects both sexes. It starts first from the foot, and then spreads up the leg to the level of the knees, and is caused by blockage of regional lymph nodes and vessels. Although both legs are involved, leg swelling tends to be asymmetrical.

Podoconiosis symptoms include leg and foot pain, flare with exertion, itching, burning, swelling in the sole of the foot, marked soft tissue thickening, underlying bone changes, and bacterial infection, If left untreated or undertreated, as well as lymphatic filariasis or any other cause of lymphedema, the condition progressed towards Stage III, also called elephantiasis, characterized by large edema, leathery pigmented foot. and lower leg disability and disfigurement.

Many patients have difficulty accessing health care due to the high costs of going to the doctor or long distances to reach providers and clinics familiar with Lymphatic Podoconiosis Disease. Because of this, many of those affected don’t complete treatment or don’t receive it at all, Due to the stigma against people with lymphatic disease, they may not seek help when first symptoms appear, causing a delay in diagnosis and development of complications and disabilities. Many people living with Podoconiosis are unable to work due to disability caused by the disease or may face the social stigma that prevents them from working. The loss of income-earning opportunities and medical expenses for patients and their families leads to socioeconomic burdens and consequent psychological stress for patients.

The good news for Podoconiosis is that established lymphatic dysfunction is treatable. Like most other clinical conditions, diseases of the Circulatory System like chronic venous insufficiency (CVI) in Peripheral vascular disease, and Lymphedema (LE) in Lymphatic vascular disease is most treatable in their earliest stages. The goals of preventive treatment in diseases of the Vascular System, are to reduce the pooling of blood in venous disease, and the pooling of lymph fluid (dermal backflow) in lymphatic disease, thus preventing limb swelling, skin complications, and disease progression

Vascular medicine or vascular surgery specialists typically recommend a combination of preventive treatments for people with Venous Insufficiency and Lymphatic Dysfunction. Some of the simple basic daily self-care preventive treatment strategies include:

  • Avoid long periods of standing or sitting

  • Exercise regularly

  • Control weight

  • Elevate your legs while sitting and lying down.

  • Wear Compression Garments.

  • Take antibiotics as needed to treat skin infections.

  • Practice good hygiene and skincare.

  • Use adequate clothing and footwear.

Education and improving access to health services are keys to the successful prevention of the elephantiasis stage (Lymphedema Stage III) and consequently the stigma and disability associated with the illness. The First-line non-surgical reduction strategy for patients with established lymphedema is Complete Decongestive Therapy (CDT). Manual Lymphatic Drainage (MLD) and compression (multilayer low-stretch bandages and gradient compression garments) are the cornerstones of therapy. Treatment is to control the clinical severity and progression of the disease and antibiotics for the infections (Dermatolymphangioadenitis-DLA (also known as Infectious Cellulitis)). With reference to DLA, studies show that advanced stages of chronic edema are a strong risk factor. Infectious cellulitis can lead to sepsis (septicemia)Read more about what are the preventive measures for Infectious Cellulitis in lymphedema HERE

Scientific studies highlight the importance and implications of compression therapy in controlling the progression of Lymphoedema. Clinical outcomes on interventions to manage lymphedema, show that simple hygiene-based measures (washing and elevation of limbs, exercise, use of footwear) are necessary, but these alone without compression are not enough to reduce the limb size and volume. Lymphedema should always be treated in its early stages, and not left undertreated till reaching its severe Stage III – elephantiasis. People with lymphedema need access to continuing care throughout their lives, both to manage the disease and to prevent progression to more advanced stages. Read more information on what is the best treatment option for Lymphedema HERE

With reference to Pediatric lymphatic dysfunction, it is essential that children diagnosed with lymphedema due to Podoconiosis, receive early preventive compression treatment with the first signs, to minimize fluid build-up and prevent later life severe clinical complications, disfigurement, and disability. Early warning signs and symptoms are important since there is no cure.

Radical reductive ablative surgery (Charles Procedure), aimed to remove the diseased skin and subcutaneous tissue in Stage elephantiasis, should always be the last option for it is frequently associated with significant blood loss, morbidity, infections, permanent disfigurement, and recurrence of symptoms. Complete Decongestive Therapy (CDT) is not limited to lymphoedema stages 0 and I, and even late Stage III lymphoedema (elephantiasis) improves greatly with good results in the majority of cases, with correct Compression Therapy and Garments, thus preventing the need for debulking techniques.

Lymphedema is a progressive disease, and early diagnosis and treatment are paramount. Therefore, it is critical to diagnose and treat both mild and early onset cases to halt the progression of this lifelong and often debilitating condition. Together, we can put a stop to discrimination and stigma against people with Podoconiosis. We can teach people to learn to recognize symptoms and know when to see a physician for diagnosis, and we can educate the community on what is the correct treatment for lymphatic vascular disease.

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