Ledderhose disease is a benign connective tissue growth in the sole of the foot. The disease belongs to the fibromatoses.
What is Ledderhose disease?
In Ledderhose’s disease, also called Ledderhose’s disease, proliferation of connective tissue occurs in the sole of the foot. This results in the formation of hardened nodules that cause pain and limit the mobility of the foot. The disease is manifested in the plantar aponeurosis (tendon plate of the sole of the foot). Ledderhose disease is classified as a fibromatosis. In addition, there is a relationship with Dupuytren’s disease. Whereas in Ledderhose’s disease the soles of the feet are affected by nodule formation, in Dupuytren’s disease this is the case on the inner surfaces of the hands. The benign disease was named after the German physician Georg Ledderhose (1855-1925), who described it. In men, Ledderhose disease occurs twice as often as in the female sex. In the disease, there is a slow growth of nodules concentrated in the center of the sole of the foot. Sometimes the growth of the nodes may be delayed, so that they temporarily stop growing. Later, their growth resumes again and unexpectedly.
Causes
Ledderhosis is caused by an increase in connective tissue. However, the causes of Ledderhosis disease that trigger the growths are not known. Myofibroblasts, which are special cells, are thought to be responsible for the proliferation of connective tissue. Medical researchers are still researching the exact correlations. Various scientists assume the influence of a genetic component in the development of Ledderhose disease. If injuries occur on the sole of the foot, the changes in the connective tissue are caused by genetic factors. In addition, the disease not infrequently occurs in families, which increases the likelihood of genetic influences. The presence of other fibromatoses such as Dupuytren’s disease is considered another significant risk factor. Diseases such as epilepsy or diabetes mellitus are also considered as possible triggers. Liver and metabolic diseases, stress, and the consumption of alcohol and tobacco are also counted among the favoring factors.
Symptoms, complaints, and signs
Ledderhose disease is noticeable in the tendon plate of the sole of the foot. Nodules form there and harden. If the nodules reach a certain size, they have an aggravating effect on the patient’s walking. Thus, they are mostly located in the middle of the sole of the foot at the arch. While in some people only a single lump forms, in others they occur more frequently. Even entire strands can form. If the nodes are distributed over the entire sole of the foot, they grow together with the muscles and the skin above them. However, there are also milder forms of Ledderhose disease in which only a small part of the plantar fascia is affected. In addition, there are no adhesions to the muscles and skin. In about a quarter of all patients, Ledderhose disease occurs in both feet. It is not uncommon for the disease to progress in episodes, so that its progression may require years.
Diagnosis and course of the disease
To diagnose Ledderhose disease, the physician first interviews the patient. In doing so, he or she obtains information about possible previous illnesses and whether certain risk factors are present. This is followed by a thorough examination of the soles of the feet. Other areas of the body are also checked for any abnormalities. Hard lumps are a typical indication. These can hardly be moved by hand. Imaging techniques are used to determine the extent of the nodules. First and foremost, this includes sonography (ultrasound examination). Furthermore, magnetic resonance imaging (MRI) can be performed to determine the exact spread of the nodes. The diagnosis is confirmed by examining the nodes with a microscope. For this purpose, a tissue sample (biopsy) is taken from the patient. Ledderhose disease is a benign chronic disease. A complete cure is not possible. However, with appropriate treatment, there is a possibility of eliminating or at least reducing the symptoms.
Complications
As a result of Ledderhose disease, affected individuals suffer from various complaints that occur mainly on the soles of the feet.In the process, patients suffer from restricted movement and, above all, pain that occurs when standing and walking. The quality of life of those affected is significantly restricted and reduced by Ledderhose disease. Other muscles can also be affected by this disease. However, the complaints often do not occur permanently, but in episodes, so that the disease is diagnosed late. As a result of the sudden restrictions in movement, it is not uncommon for those affected to suffer from depression or psychological complaints. In children, Ledderhose disease can lead to developmental disorders and possibly delay development. Unfortunately, a causal treatment of Ledderhose disease is not possible. For this reason, treatment is aimed primarily at limiting pain and restricted movement. Complications usually do not occur. With the help of various therapies and the use of medications, many complaints can be limited so that the affected person can go about a normal daily life. Furthermore, however, Ledderhose disease can recur. However, the life expectancy of the patient is not affected by this disease.
When should one go to the doctor?
If a hard, immobile lump in the foot is noticed, a doctor should be consulted. However, this by no means has to hide Ledderhose disease. The contact person for pain or newly appeared lumps in the foot is the orthopedist. The general practitioner can also take a look at the foot and refer the patient to a specialist if necessary. If the diagnosis is unclear, a magnetic resonance imaging scan may be ordered if Ledderhose disease is suspected. To confirm the diagnosis, the physician may perform a biopsy for further examination of the nodule. The benign nature of the nodule must be established. Regular visits to the doctor are normal in the presence of Ledderhose disease. Unfortunately, surgical treatment often leads to recurrences. It is therefore usually avoided. The frequently prescribed therapeutic approaches slow down the spread of the nodular tissue. Special insoles can reduce pressure in the benign fibromatoses. The extent of the growths determines how often a visit to the doctor is indicated to adjust therapeutic measures. The growths can be irradiated. Physiotherapeutic treatments are also possible for Ledderhose disease. All therapeutic measures can, at best, slow nodule formation. Cure is not in sight for the time being when Ledderhose disease is diagnosed.
Treatment and therapy
One of the most important goals in treating Ledderhose disease is to push back the inflammation and reduce the pain. In addition, the patient should be able to walk again. To maintain the ability to walk, soft insoles are usually used. These relieve the internal pressure that is exerted on the nodes. To treat the pain, the doctor usually administers non-steroidal anti-inflammatory drugs (NSAIDs) to the affected person, which at the same time have an effect on the inflammation. At the same time, steroid injections are given into the nodes. In the early stages of Ledderhose disease, radiotherapy is also considered promising, using soft X-rays. Injection of collagenases or shock wave therapy (ESWT) are also considered useful. These lead to the loosening of the hard nodes. Cryotherapy, in which the physician treats the patient with cold, is also considered promising. If the disease is already at an advanced stage, surgical intervention may be necessary. This often involves the complete removal of the tendon plate. In contrast, partial surgery often leads to a recurrence of nodules. However, even with complete removal of the plantar fascia, there is a risk of recurrence of fibromatosis in about 25 percent of all patients. In addition, injury to tendons, nerves, and muscles can occur during surgery.
Outlook and prognosis
Ledderhose disease typically takes a relapsing course that lasts for several years. Nevertheless, the prognosis is very good. It is usually sufficient to remove the affected fascia and correct the trigger of Ledderhose disease. X-ray treatment involves radiation exposure, which may cause physical discomfort. Since mainly soft X-rays are used in the therapy of Ledderhose’s disease, the risk of serious side effects is relatively low.The use of collagenase or shock wave therapy is also unproblematic and promising. The prognosis is positive if the condition occurs as side effects of drugs such as primidone or phenobarbital. In most cases, it is sufficient to discontinue the triggering drugs. Life expectancy is not limited by Ledderhose disease. However, the quality of life may be reduced during the period of the disease, as the feet hurt a lot and the patient can hardly step on the soles without feeling intense pressure pain. This can lead to severe discomfort and limitations in everyday life, especially during the acute phase of the condition. The general practitioner or podiatrist can make a reliable prognosis, taking into account the cause of the condition and the patient’s constitution.
Prevention
The way in which Ledderhose disease develops could not be determined so far. For this reason, no preventive measures are known.
Aftercare
Medical aftercare for Ledderhose disease is only necessary if surgery is performed. Otherwise, follow-up care is not required. Symptomatic medications or other nonsurgical treatment measures never necessitate follow-up. In some cases, treatment does not even occur due to an acceptable level of suffering. If surgery is performed to remove the hardened tissue from the soles of the feet, a whole series of aftercare measures must be observed afterwards. This can be explained by the fact that the feet are already subjected to a lot of stress in ordinary everyday life. The proper healing of the wounds and scars is thus made considerably more difficult. In addition to a very pronounced protection of the feet, which can be achieved by the patient by refraining from walking and standing, special attention must also be paid to wound hygiene. Keeping the wound clean and protecting it from perspiration simplifies healing and prevents infections. Depending on the extent of the operation, the specialist in charge must work out an appropriate healing plan with the patient. After a few weeks, when the soles of the feet have healed, the feet can gradually be loaded again. To what extent this should be done gradually also depends on the extent of the operation. If only individual nodules are removed, the sole is less affected than with a complete fasciectomy.
What you can do yourself
Because Ledderhose disease is not curable, patients must learn to manage the condition long-term. In some cases, it is recommended to seek psychological help in addition to medical treatment. In addition, those affected can exchange information on self-help in various Internet forums. In larger cities, there are also self-help groups for people suffering from Ledderhose disease or fibromatoses in general. There they can also find more detailed information on self-help measures. It is also important to care for the feet regularly and to avoid injuries. Irritation of the soles of the feet should be avoided. When buying shoes, make sure that they fit well. If necessary, affected persons should resort to orthopedic custom-made shoes or use insoles. In some cases, regular barefoot walking over soft surfaces such as grass, sand or mud can help. Cooling as well as gentle massages can also lead to improvement or prevent worsening. It is also recommended to change the diet and reduce the intake of glucose and carbohydrates. Foods that contain many natural antioxidants have a supportive effect. It is therefore advisable to consume as much fruit and vegetables as possible, as well as legumes. Alcohol and coffee can usually still be consumed in moderation.
