Healing

M. Ledderhose is a benign connective tissue proliferation, which can be treated with various therapeutic approaches. Conservative treatments make it possible to prevent or even completely eliminate the progression of the nodular growths. However, M. Ledderhose has the characteristic of occurring in relapses and of following a progressive (= progressing) course.

This means that even after successful therapy and after phases of freedom from symptoms, a new episode occurs and the nodular changes become symptomatic again. Even surgical removal cannot provide a lifelong guarantee that the disease will not reoccur. The recurrence rate is very high, as with the analogous clinical picture of Dupuytren’s disease.

Risk factors

Why at all a disease Ledderhose occurs, is unfortunately still not exactly known until today. At present there are already defined risk factors that favor the occurrence of plantar fascial fibromatosis. These include: Further factors, whose clear connection could not be proven however yet: Smoking, alcoholism, liver diseases, thyroid diseases, stress.

Familial frequency of the disease
Gender (men are more often affected than women)
Fibromatosis in the hand (this increases the risk to 10-65%)
Induratio penis plastica disease
Epilepsy
Diabetes mellitus

Analogies to Dupuytren’s disease

The clinical picture of M. Ledderhose, like Dupuytren’s contracture, belongs to the group of benign connective tissue growths known as fibromatosis. Ledderhose disease is a connective tissue disease of the tendon plate (aponeurosis) of the feet, the plantar aponeurosis. Similarly, the disease on the hands is called Dupuytren’s disease and affects the tendon plate of the hand, the palmar aponeurosis.

What both have in common is that it is a benign, connective tissue proliferation that can grow into the surrounding tissue and is largely based on the proliferation of special cells, the so-called myofibroblasts. In addition, both diseases have a high risk of recurrence after surgical removal, i.e. even after complete removal, the nodular changes can recur again and again. A third related disease affects the penis and is called “Induratio penis plastica”, a scarring of certain skin layers, which is associated with a painful curvature of the penis during erection and the risk of erectile dysfunction.Of the 3 fibromatoses mentioned above, Dupuytren’s contracture is the most common and best known clinical picture.

Despite the many similarities, M. Ledderhose and M. Dupuytren’s differ in a few aspects. On the one hand, Dupuytren’s disease is characterized by an inhibition of finger extension, hence the synonym Dupuytren’s contracture (contracture = shortening of muscles and tendons). This symptom does not occur on the foot, however, as the toes are usually not affected to this extent. On the other hand, the nodular changes in the plantar aponeurosis of the foot tend to be much larger than those in the palmar aponeurosis of the hand.