We need a low-cost way to treat this devastating disease

Podoconiosis, caused by mineral triggers in volcanic soil, results in massive swelling of the legs, disfiguring of the feet and severe pain, particularly among barefoot farmers who cannot afford shoes. Patients cannot move their legs and are often confined to bed.

A new study by the Brighton and Sussex Medical School, run jointly by the universities of Brighton and Sussex and published in The Lancet Global Health, shows that a simple package of self-care significantly reduced acute attacks among podoconiosis patients. The study was jointly funded by the Wellcome Trust, the UK Medical Research Council and UKAid.

The researchers are now asking governments in developing countries to adopt a low-cost, community-based approach to prevent acute attacks.

Podoconiosis is a progressive and disabling form of leg swelling

Professor Gail Davey

Researchers conducted a trial in Northern Ethiopia to test the hypothesis that a simple, inexpensive lymphoedema management package would reduce the incidence of acute episodes in adult podoconiosis patients.

Around 700 patients were individually randomised to a package comprising instruction in foot hygiene, skin care, bandaging, exercises, use of socks and shoes, with support by lay Community Podoconiosis Agents at monthly meetings; or had no intervention. Both groups were followed up after a year, and the group which received the intervention showed a marked reduction in acute episodes, with a reduction in episode rates of almost 20 per cent in those treated.

Professor Gail Davey, Professor of Global Health Epidemiology at BSMS, who led the study, said: “In most countries that suffer from podoconiosis, there are not yet policies in place to manage this debilitating disease, largely due to limited awareness of the condition and lack of evidence for treatment.

“Our rigorous study provides vital evidence that a simple and cost-effective package of community-managed self-care could have a significant impact on the incidence of acute attacks in people with podoconiosis. Not only would implementing such an approach on a national scale reduce suffering and stigma among many of the poorest communities, it would have a significant impact on these communities’ social and economic wellbeing. We would urge governments of countries with high prevalence of podoconiosis to develop policies for its management that include such a community-based approach.”