Some podoconiosis patients will develop symptoms that need urgent referral for further care at a higher health facility or hospital. Here are some of the warning signs:

• Red hot leg. Sometimes, people with podoconiosis develop bacterial superinfection ('added infection' by bacteria that usually live on the skin) in the swollen leg. They report aching pain and increased heat and swelling in the leg, fevers or chills, and sometimes headaches. They need antibiotics to control the infection, and painkillers.
• Open wounds. After an injury, a person with podoconiosis is more likely to develop an open wound that may not heal easily. Careful wound care using clean techniques and local dressing materials will be needed, most likely at a higher health facility.
• Deep fungal infection (a fungus has taken root deep in the swollen tissues). The patient may notice black dots on the surface of the skin. They need hospital treatment.
• Skin cancer. Looking carefully, you will see an ulcer with a rolled edge (like rolled injera). This needs hospital treatment.