Physiotherapy

Ledderhose disease is a chronic disease that cannot be cured by physiotherapy. However, various measures can be taken to influence the symptoms caused by the contracture, as well as the course and subsequent symptoms. The formation of nodules in the tissue of the plantar fascia causes various symptoms.

The tendon becomes more inelastic, which can lead to restrictions in movement and tension even further along the muscle chain along the leg.Tension pains, malpositioning of the toes and a change in gait pattern can develop. The foot becomes less resilient due to the pain, especially when walking and standing for long periods. The symptoms develop individually and according to the characteristics of the connective tissue nodes.

The therapy is also based on this. The main aim is to keep the tissue elastic and the joints flexible. The exercise of a normal gait pattern should be maintained or practiced again. Education of the patient about active participation, everyday behavior and a healthy lifestyle in general are part of the therapy.

Causes

The cause of Ledderhose disease is unknown. It is a benign tumor, i.e. cells proliferate, form nodules, but do not destroy other tissue. Possible factors contributing to the development of the disease are genetic – i.e. hereditary – but this cannot be proven with certainty.

Furthermore, immune diseases or metabolic disorders are considered as possible causes. Ledderhose disease often occurs together with a similar disease of the hand, Dupuytren’s contracture. In the same way that nodules occur in the sole of the foot as described above, in Dupuytren’s disease nodules occur in the tendons of the palm of the hand, which leads to malpositioning of the fingers. Many of the patients affected by Ledderhose disease also suffer from Dupuytren’s disease, but conversely, only a few Dupuytren’s patients also suffer from Ledderhose contracture, which occurs relatively rarely.

Pain in the ball of the foot

The tendon affected in Ledderhose disease, the plantar fascia, runs from the heel bone in the ball of the foot to the toe bones, where it attaches. This causes the foot bones to be braced together and the longitudinal arch, which is important for cushioning, is formed. The heel is the fixed end of the tendon, the attachment to the freely movable toes is the mobile end.

If fiber adhesions in the form of nodules occur in plantar fibromatosis, the tendon becomes less elastic and contracts (shrinks), which is why it is also referred to as a lederhosen contracture. At the “mobile” end, the tendon pull can result in a curvature of the freely moving toes. At the “fixed” end, however, the fixed tendon pulls at its bony origin, which can lead to periosteal irritation and inflammation.

Thus, pain at the ball of the foot is a typical symptom of Ledderhose disease. Other causes of heel pain that can be isolated or excluded are, for example, heel spurs, diseases or shortening of the Achilles tendon, shortening of the plantar fascia that can be explained in other ways, such as simple overstrain in athletes/runners or bursitis. Not every pain at the ball of the foot is necessarily indicative of Ledderhose disease.