Which doctor should I see?

As a rule, the family doctor is consulted the first time symptoms occur or when the tumor on the sole of the foot is noticed without symptoms, since the layman usually does not know what this connective tissue change may be. Depending on experience and the equipment of imaging devices (ultrasound), the family doctor can make the diagnosis himself. For more precise clarification, he can also issue a referral for an MRI to a radiologist (radiologist), who can ultimately confirm the diagnosis with the help of the images.

The family doctor can also be consulted for conservative therapeutic measures. Depending on the further treatment, the nodular change may have to be surgically removed by a surgeon. These are usually foot surgeons, who perform the procedure as in-patients but often also as out-patients. Since foot surgery is a specialty, it is recommended to have the operation performed in a specialized clinic.

Therapy

An important guideline in the treatment of Ledderhose disease is to inhibit the inflammation and pain, as well as to maintain the patient’s ability to walk. Soft insoles can be prescribed which can prevent the internal pressure on the nodes. For the inflammation and pain, non-steroidal anti-inflammatory drugs are often prescribed, as well as steroid injections into the nodes.

In the early stages, radiotherapy with soft X-rays often shows good results. Furthermore, therapy with shock waves or the injection of collagenases, which are supposed to loosen the hardened nodules, has also brought good results. In case of existing complaints and in advanced stages, Ledderhose disease requires surgery.

Radical removal of the plantar fascia is often recommended, since even faster growing nodes often reappear with minimal surgery. However, it must also be explained to the patient that the possibility of a return of fibromatosis is 25%. In addition, the risks of an operation on the sole of the foot must be explained.

Nerves, muscles and vision are close together and could be injured. The use of radiotherapy in the treatment of Ledderhose disease is particularly important in the early stages. In some studies the effectiveness of radiotherapy has been shown.

With regard to the radiation used, a distinction must be made between two different forms of radiation. Mild X-rays (orthovolt therapy) and electron beams are used. The radiation energy used in these treatments of Ledderhose disease is only a fraction of that used for malignant, solid tumors.

Nevertheless, there is a certain risk for the treated person, which is why, as a rule, only persons over 45 years of age receive radiation therapy. The treatment options for Ledderhose disease can be divided into conservative and surgical treatment options. If conservative methods are not successful, surgery may be considered.

There are two different options for surgery on the nodes on the sole of the foot. On the one hand, only the nodes can be removed. This initially provides freedom from symptoms, but is associated with a high probability that further, even more aggressive and larger nodules will develop in the course of time.

The probability of recurrence with this type of removal is up to 85%. The second possibility is the removal of the nodules and the simultaneous removal of the so-called plantar fascia (plantar fasciaectomy). This fascia is a tendon plate which is located on the sole of the foot and is the starting point for the development of the nodes.

But even after the removal of the plantar fascia, recurrences can occur. The probability of recurrence after this operation is about 25%.Since the probability of recurrence is much lower, many doctors advise the latter when choosing between operations. This is also justified by the fact that the recurrences that occur are more aggressive and a second operation has a higher risk of complications due to the scar tissue that has formed.

However, it should be mentioned that the removal of the plantar fascia is not without consequences for the affected person. Thus, further complaints may occur while walking, which the attending physician must inform about before the operation is performed. If the skin is so severely damaged by the connective tissue growths that it must be removed over a large area, it may be necessary to perform a skin transplant on the sole of the foot.

In both operations the affected foot should be protected for up to three weeks. This is necessary to allow the wound to heal as quickly as possible and to reduce the probability of recurrence. In addition to the classic treatment approaches, such as conservative and/or surgical care and radiotherapy, homeopathy is becoming more and more popular.

With different homeopathic remedies, homeopathy aims to relieve pain and inflammation. One substance that is supposed to help in the homeopathic treatment of Ledderhose disease is formic acid (Acidum formicicum). The treatment involves injecting formic acid in the area of plantar aponeurosis, i.e. at the site of manifestation.

This procedure is described by patients as very painful, but it must be repeated several times for therapy to be successful. Currently, however, there are no studies that confirm the benefit or effectiveness of homeopathic treatment. Therefore, if the therapeutic benefit is insufficient and the pain during the application of formic acid injections is too severe, it is not uncommon for patients to resort to drug or surgical treatment.