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| '''Ledderhose's Disease''', also known as '''Morbus Ledderhose''', '''plantar fibromatosis''', and '''plantar aponeurosis''', is a non-malignant thickening of the feet's deep connective tissue, or ]. In the beginning, where nodules or cords start growing along ]s of the foot, the disease is minor, or not painful. Eventually, however, the cords thicken, the toes stiffen and bend, and walking becomes painful. The disease is named after |
'''Ledderhose's Disease''', also known as '''Morbus Ledderhose''', '''plantar fibromatosis''', and '''plantar aponeurosis''', is a relatively uncommon<ref name="scidir"></ref> non-malignant thickening of the feet's deep connective tissue, or ], with a tendency to locally recur<ref></ref>. In the beginning, where nodules or cords start growing along ]s of the foot, the disease is minor, or not painful. Eventually, however, the cords thicken, the toes stiffen and bend, and walking becomes painful. The disease is named after George Ledderhose (1855 - 1925), a German surgeon who described the condition for the first time in 1897.<ref name="patuk"></ref> A similar disease is ], which affects the hand and causes bent hand or fingers. | ||
| As in most forms of ], it is usually benign and its onset varies with each patient.<ref name="bun"></ref> The nodules are typically slow growing<ref name=scidir/><ref name=bun/> and most often found in the central and medial portions of the plantar fascia<ref name=scidir/>. Occasionally, the nodules may lie dormant for months to years only to begin rapid and unexpected growth.<ref name=bun/> It need only be surgically removed if discomfort hinders walking.<ref name=pubmed></ref> | |||
| ==Symptoms== | |||
| Plantar fibromatosis is most frequently present on the medial border of the sole, near the highest point of the arch.<ref name=pubmed/> The lump is usually painless<ref name=pubmed/> and the only pain experienced is when the nodule rubs on the shoe or floor.<ref name=bun/> The overlying skin is freely movable, and contracture of the toes does not occur in the initial stages.<ref name=pubmed/> | |||
| The typical appearance of plantar fibromatosis on ] (MRI) is a poorly defined, infiltrative mass in the aponeurosis next to the plantar muscles.<ref name="rad"></ref> | |||
| ==Risk Factors== | |||
| As with Dupuytren's disease the root causes of Ledderhose's disease are not yet understood. It has been noted that it is an inherited disease and of variable occurrence within families, ie. the genes necessary for it may remain dormant for a generation or more and then surface in an individual, or be present in multiple individuals in the same generation with varying degree.<ref name="drg"></ref> | |||
| There are certain identified risk factors - | |||
| *A family history of the disease<ref name=drg/> | |||
| *Higher incidence in males<ref name=rad/> | |||
| *Associated with ] 10-65% of the time.<ref name=rad/> | |||
| *Associated with ].<ref name=pubmed/> | |||
| ==Treatment== | |||
| Although the origin of the disease is unknown, there is speculation that it is an aggressive healing response to small tears in the plantar fascia, almost as if the fascia over-repairs itself following an injury.<ref name=bun/> | |||
| In the early stages, when the nodule is single and/or smaller, it is recommended to avoid direct pressure to the nodule(s). Soft inner soles on footwear and padding may be helpful.<ref name=bun/> | |||
| MRI is effective in showing the extent of the ], but cannot reveal the tissue composition. Even then, recognition of the imaging characteristics of plantar fibromatoses can help in the clinical diagnosis.<ref name=scidir/> | |||
| Surgery of Ledderhose's disease is difficult because tendons, nerves, and muscles are located very closely to each other. Additionally, feet have to carry heavy load, and surgery might have unpleasant side effects. If surgery is performed, the biopsy is predominantly cellular and frequently misdiagnosed as ].<ref name=pubmed/> Since the diseased area (lesion) is not encapsulated, clinical margins are difficult to define. As such, portions of the diseased tissue may be left in the foot after surgery. Inadequate excision is the leading cause of recurrence.<ref name=scidir/><ref name=rad/> Post-surgical radiation treatment may decrease recurrence.<ref name=rad/> There has also been variable success in preventing recurrence by administering gadolinium.<ref name=rad/> | |||
| ⚫ | If the disease has not progressed too far, radiation therapy has proven to relieve and even cure Ledderhose's disease.{{fact}} Triamcinolol acetonid (triamcinolone; brand names e.g. Kenalog, Aristocort or Triderm) is injected to soften nodules and reduce their size.{{fact}} In few cases shock waves also have been reported to at least reduce pain and enable walking again.{{fact}} Currently in the process of FDA approval is the injection of ].{{fact}} Recently successful treatment of Ledderhose with ] (also called cryotherapy) has been reported.{{fact}} | ||
| ==See Also== | |||
| *] | |||
| *] | |||
| ==References== | |||
| {{reflist}} | |||
| Ledderhose's disease is the equivalent disease to ], which affects the hand and causes bent hand or fingers. As with Dupuytren's disease the root causes of Ledderhose's disease are not yet understood, though an inclination is probably inherited. Men typically get the disease at an earlier age than women. At the age of 80 the probability to suffer from Dupuytren's disease becomes about even for men and women (we have no statistics on Ledderhose's disease), with men typically in a more progressed stage. | |||
| ⚫ | |||
| ==External links== | ==External links== | ||
| * Describes treatments for Ledderhose's disease. | * Describes treatments for Ledderhose's disease. | ||
Revision as of 20:45, 27 December 2007
Ledderhose's Disease, also known as Morbus Ledderhose, plantar fibromatosis, and plantar aponeurosis, is a relatively uncommon non-malignant thickening of the feet's deep connective tissue, or fascia, with a tendency to locally recur. In the beginning, where nodules or cords start growing along tendons of the foot, the disease is minor, or not painful. Eventually, however, the cords thicken, the toes stiffen and bend, and walking becomes painful. The disease is named after George Ledderhose (1855 - 1925), a German surgeon who described the condition for the first time in 1897. A similar disease is Dupuytren's disease, which affects the hand and causes bent hand or fingers.
As in most forms of fibromatosis, it is usually benign and its onset varies with each patient. The nodules are typically slow growing and most often found in the central and medial portions of the plantar fascia. Occasionally, the nodules may lie dormant for months to years only to begin rapid and unexpected growth. It need only be surgically removed if discomfort hinders walking.
Symptoms
Plantar fibromatosis is most frequently present on the medial border of the sole, near the highest point of the arch. The lump is usually painless and the only pain experienced is when the nodule rubs on the shoe or floor. The overlying skin is freely movable, and contracture of the toes does not occur in the initial stages.
The typical appearance of plantar fibromatosis on Magnetic resonance imaging (MRI) is a poorly defined, infiltrative mass in the aponeurosis next to the plantar muscles.
Risk Factors
As with Dupuytren's disease the root causes of Ledderhose's disease are not yet understood. It has been noted that it is an inherited disease and of variable occurrence within families, ie. the genes necessary for it may remain dormant for a generation or more and then surface in an individual, or be present in multiple individuals in the same generation with varying degree.
There are certain identified risk factors -
- A family history of the disease
- Higher incidence in males
- Associated with palmar fibromatosis 10-65% of the time.
- Associated with epilepsy.
Treatment
Although the origin of the disease is unknown, there is speculation that it is an aggressive healing response to small tears in the plantar fascia, almost as if the fascia over-repairs itself following an injury.
In the early stages, when the nodule is single and/or smaller, it is recommended to avoid direct pressure to the nodule(s). Soft inner soles on footwear and padding may be helpful.
MRI is effective in showing the extent of the lesion, but cannot reveal the tissue composition. Even then, recognition of the imaging characteristics of plantar fibromatoses can help in the clinical diagnosis.
Surgery of Ledderhose's disease is difficult because tendons, nerves, and muscles are located very closely to each other. Additionally, feet have to carry heavy load, and surgery might have unpleasant side effects. If surgery is performed, the biopsy is predominantly cellular and frequently misdiagnosed as fibrosarcoma. Since the diseased area (lesion) is not encapsulated, clinical margins are difficult to define. As such, portions of the diseased tissue may be left in the foot after surgery. Inadequate excision is the leading cause of recurrence. Post-surgical radiation treatment may decrease recurrence. There has also been variable success in preventing recurrence by administering gadolinium.
If the disease has not progressed too far, radiation therapy has proven to relieve and even cure Ledderhose's disease. Triamcinolol acetonid (triamcinolone; brand names e.g. Kenalog, Aristocort or Triderm) is injected to soften nodules and reduce their size. In few cases shock waves also have been reported to at least reduce pain and enable walking again. Currently in the process of FDA approval is the injection of collagenase. Recently successful treatment of Ledderhose with cryosurgery (also called cryotherapy) has been reported.
See Also
References
- ^ Science Direct
- Medical Dictionary
- patient.co.uk
- ^ Bunion Busters
- ^ Pub Med Central
- ^ rad.usuhs.edu
- ^ DrGreene.org
External links
- Official Dupuytren Society Website Describes treatments for Ledderhose's disease.