Symptoms

With Ledderhose disease, the ability to walk is usually impaired. This is because the nodes are located on the sole of the foot, especially at the highest point of the arch of the foot in the middle of the sole. There can be only one knot, but also several knots and strand formations.

If these are pronounced and distributed over the entire sole of the foot, the nodes are usually firmly attached to the muscles and the skin above them. In contrast, in the mild form of Ledderhose disease, only a small part of the plantar fascia is affected and neither the skin nor the muscles show adhesions. Approximately 25% of those affected have Ledderhose disease on both feet.

Diagnosis

The diagnosis of Ledderhose disease begins with the patient’s medical history. Due to the typical complaints that typically occur when walking, which are often the first thing the person concerned notices, as well as the physical examination, the attending physician can often already make a suspected diagnosis of Ledderhose disease. During the examination of the foot, relatively hard knots are noticeable, which are difficult to move with the hand.

To determine the actual size of the nodules, diagnostic imaging equipment is used. Especially the performance of an ultrasound examination can be carried out in many practices of general practitioners. In order to get a more precise picture of the individual spread of the nodules, images can also be produced with a magnetic resonance tomograph (MRT).

Absolute certainty about the presence of Ledderhose disease can be obtained by microscopic examination of the nodes. The examined material can be removed by biopsy or during surgery to remove the nodules and examined by a specialist in pathology. In the magnetic resonance tomogram, the typical Ledderhose’s disease node appears as a poorly defined, infiltrating mass in the tendon plate near the sole of the foot muscle.

To exclude possible differential diagnoses of nodular changes in the foot, a magnetic resonance imaging examination, i.e. an MRI of the foot, is indicated. The MRI is particularly well suited for imaging soft tissue. Since the nodular changes in Ledderhose disease are connective tissue cell material, this can be recognized as a mass of space starting from the tendon plate of the foot (plantar aponeurosis) in the MRI.The signal intensity can be evaluated in different sequences.

In the possible sequences, the connective tissue-like change appears low-signal, i.e. dark, in comparison to the surrounding tissue. Furthermore, it can be seen that the fibromatous structure grows infiltrating, i.e. pulling into surrounding structures such as muscles, tendons, fat and skin. If contrast medium is additionally injected, an even contrast medium enrichment of the tissue can be observed.