Morbus Ledderhose is a disease in which a benign knot on the inside of the foot is formed. The corresponding clinical picture on the hand is Morbus Dupuytren. The nodules can form in the connective tissue of the fascia and tendon plates and in rare cases can form strands.
At the beginning, the nodules, which usually form in the arch of the foot at the plantar aponeurosis (plantar fibromatosis) are usually small and do not cause any symptoms. The increasing size of the nodes in the arch of the foot can cause pain, for example when rolling or walking on hard ground with little padded footwear. In contrast to Dupuytren’s contracture, there is rarely a direct restriction of movement of the toes, but rather the pressure of the knot itself is the cause of the pain symptoms. Ledderhose disease is not the only disease that causes the formation of a knot on the sole of the foot. A medical diagnosis should therefore be made urgently before starting a therapeutic procedure.
Causes
The exact cause of the connective tissue proliferation in Ledderhose disease is not known. Presumably, overactivity of the fibroblasts that produce connective tissue occurs. Genetic factors come into consideration. An increased cell activity could be caused by previous injuries on the foot, furthermore, alcohol and tobacco consumption are also considered risk factors for fibromatosis as in Dupuytren’s disease. Dupuytren’s disease and Ledderhose disease are both fibromatoses; Ledderhose disease occurs much less frequently.
Physiotherapy
In the physiotherapeutic treatment of Ledderhose disease, it is important to keep the connective tissue as mobile as possible and to maintain flexibility so that the tissue remains resilient and elastic. Stretching techniques in which the arch of the foot is actively or passively expanded and stretched are suitable for this purpose. The hardening itself can be treated manually using specific trigger, massage and fascial techniques.
Here, the tissue is stretched and mobilized by a dosed pressure load. Pain can sometimes occur, but should be bearable in any case. Consultation with the therapist is desired.
However, it is particularly important not to set inflammatory stimuli during friction treatment, which could promote further proliferation of the tissue. It is particularly important to maintain or restore a physiological gait pattern. Therefore, gait training and possible gait improvement are also part of the physiotherapeutic treatment of Ledderhose disease.
Gentle mechanisms can be balanced, overstressed structures are relieved. If necessary, electrotherapy can be used as well as the application of ice (cryotherapy). These mechanisms can favorably change the metabolic situation in the affected tissue.
