Ledderhose disease, also known as plantar fibromatosis, is a relatively rare condition affecting the connective tissue on the bottom of the foot. It is characterized by the formation of firm, non-cancerous growths, or nodules, within the plantar fascia. This thick band of tissue runs along the sole of the foot, connecting the heel bone to the toes. While the growths are benign, their presence can lead to discomfort and mobility issues.
Defining the Condition and Its Manifestation
The hallmark of Ledderhose disease is the presence of one or multiple fibrous nodules, known as fibromas, embedded within the arch of the foot. These growths result from a hyperproliferation of fibroblasts and collagen, causing a localized thickening of the plantar fascia. The nodules typically feel hard, firm, or rubbery to the touch and are most commonly found in the central medial band of the fascia.
The size of these fibromas can vary, often measuring up to two or three centimeters. Initially, the nodules may be painless and are only noticed as small lumps under the skin. Discomfort usually begins when the growths enlarge enough to create pressure during weight-bearing activities like standing or walking. As the disease progresses, the pain can become more persistent, and in rare cases, the thickened tissue may lead to a contracture or curling of the toes.
Underlying Causes and Risk Factors
The precise cause of Ledderhose disease remains largely unknown, making its origin idiopathic in many individuals. However, a combination of genetic and environmental factors is thought to contribute to the condition, as a genetic predisposition is suggested when the disease appears to run in families.
The condition shows a higher prevalence in men and individuals who are middle-aged or older. Ledderhose disease has a strong association with other forms of fibromatosis, disorders involving excessive fibrous tissue growth. These related conditions include Dupuytren’s contracture in the hand, Peyronie’s disease, and knuckle pads; up to 50 percent of Ledderhose patients also have Dupuytren’s contracture. Risk factors also include systemic diseases and lifestyle factors, such as diabetes mellitus, chronic liver disease, long-term alcohol consumption, and the use of certain anticonvulsant medications.
Diagnosis and Conservative Management
Diagnosis typically begins with a physical examination, where a physician palpates the characteristic firm nodules within the arch of the foot. The patient’s medical history, particularly any family history of fibromatoses, provides additional context. To confirm the diagnosis and assess the extent of the growths, imaging studies are employed.
Ultrasound is commonly used to visualize the nodules and confirm their fibrous nature within the plantar fascia. Magnetic Resonance Imaging (MRI) may be requested in advanced cases to better delineate the size and depth of the growths, and to help rule out other potential soft tissue masses.
Initial treatment focuses on conservative, non-surgical approaches aimed at reducing symptoms. Custom-made orthotics and padding are often prescribed to cushion the fibromas and redistribute mechanical pressure away from painful areas during standing or walking. Physical therapy, including stretching and massage, may also be helpful in maintaining flexibility and easing discomfort. For localized pain and inflammation, corticosteroid injections may be administered directly into the nodule.
Advanced Treatment Options
When conservative measures fail to provide adequate relief, or when the nodules significantly impair walking, more advanced treatments are considered. One option is low-dose radiation therapy, which can be effective in the early stages of the disease. This non-invasive treatment targets the hyperactive fibroblasts in the nodules to slow their growth and potentially reduce their size.
Surgical intervention is generally reserved as a last resort due to potential complications and a high rate of recurrence. The procedure, typically a partial or total plantar fasciectomy, involves the excision of the nodules along with a section of the surrounding fascia. While surgery provides immediate relief from pain, recurrence rates can be substantial, sometimes as high as 60 percent. The formation of painful scar tissue is another concern, which can be as debilitating as the original condition.