Podoconiosis, a neglected tropical disease

Podoconiosis or 'endemic non-filarial elephantiasis' is a tropical disease caused by exposure of bare feet to irritant alkaline clay soils. This causes an asymmetrical swelling of the feet and lower limbs due to lymphoedema. Podoconiosis has a curable pre-elephantiasic phase. However, once elephantiasis is established, podoconiosis persists and may cause lifelong disability. The disease is associated with living in low-income countries in the tropics in regions with high altitude and high seasonal rainfall. It is found in areas of tropical Africa, Central and South America and north-west India. In endemic areas, podoconiosis is a considerable public health problem. Social stigmatisation of patients is widespread and economic losses are enormous since it mainly affects the most productive people, sustaining the disease-poverty-disease cycle. Podoconiosis is unique in being an entirely preventable, non-communicable tropical disease with the potential for eradication. Low-cost preventive measures are a simple but effective solution. However, so far it has received little attention from health care policy makers and, until recently, research into the disease has been scarce and the pathogenesis and genetic basis are partly unclear. A better understanding of these aspects may lead to new prevention and treatment opportunities. In the past few years, several projects fighting podoconiosis have been started by non-governmental organisations. In February 2011, the World Health Organisation designated podoconiosis as one of the 20 neglected tropical diseases, marking an important step in the fight against the disease.