Ledderhose Disease

What Is It, Causes, Treatment, and More

Author: Anna Hernández, MD

Editors: Alyssa Haag, Lily Guo, Kelsey LaFayette, DNP

Illustrator: Jessica Reynolds, MS

Copyeditor: David G. Walker

What is Ledderhose disease?

Ledderhose disease, also known as plantar fibromatosis, is a rare and benign foot disorder that causes small nodules to appear in the soles of the feet. It is often associated with other forms of fibromatosis, including Dupuytren disease, which causes flexion contractures of the hand; Peyronie disease, which causes a distinctive curvature of the penis that can make erections painful; and knuckle pads, which are fibrous growths in the knuckles of the fingers or toes.

Small nodules on the bottom of a foot.

What causes Ledderhose disease?

Ledderhose disease occurs due to fibrosis and proliferation of specialized cells called fibroblasts in the plantar fascia, a thick band of connective tissue that helps to protect the soles of the feet from injury and supports the arches of the foot. While the exact mechanism of nodule formation is currently unknown, it seems that both genetic and environmental factors play a role in its development. Individuals who have a family history of Ledderhose disease or other forms of fibromatosis have an increased risk of developing the condition. In addition, repeated trauma, alcohol use disorder, chronic liver disease, diabetes mellitus, and epilepsy have also been reported in association with this condition. Although anyone can be affected, it is more common in individuals assigned male at birth and typically affects middle aged and older people. 

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What are the signs and symptoms of Ledderhose disease?

Ledderhose disease is characterized by the growth of small nodules on the soles of the feet, most commonly on the medial, or inner part, of the plantar fascia. These nodules are usually painless at first but, as they grow, may become uncomfortable or painful when walking. Typically, nodules are slow-growing; however, they may occasionally go through a period of rapid growth. Unlike Dupuytren disease, Ledderhose disease rarely causes contractures of the toes.

How is Ledderhose disease diagnosed?

Diagnosis of Ledderhose disease can be suspected based on the physical examination of the soles of the feet. Usually, imaging tests, like an ultrasound or MRI of the feet, are performed to distinguish between other possible causes of midfoot pain, such as ganglion cysts. Additionally, MRI can be used to determine the extent of the lesion and to create a plan for surgical removal. 

How is Ledderhose disease treated?

Treatment of Ledderhose disease depends on the signs and symptoms and preferences of the individual. Conservative treatment is preferred in small and minimally painful lesions and includes measures to avoid direct pressure to the nodules, such as soft inner soles or extra padding on footwear. Adjunctive medications, like non-steroidal anti-inflammatory drugs (NSAIDs), or physical therapy may also be helpful to relieve the pain. 

For larger lesions, direct injections of corticosteroids into the nodules may help reduce their size and reduce pain. Alternatively, radiation therapy has been shown in several studies to reduce the size of the nodules and the pain associated with them with minimal side effects. 

For individuals that have painful lesions that do not respond to conservative treatment or that are activity-limiting, surgery might be an effective option. Usually, a total fasciectomy, or removal of the whole plantar fascia, is preferred over local removal of the nodule due to a higher risk of recurrence with the latter. However, a fasciectomy is a more aggressive procedure and has a higher risk of complications, like painful scars and wound infection. 

What are the most important facts to know about Ledderhose disease?

Ledderhose disease is a disorder of connective tissue that causes nodules to appear in the soles of the feet, which can cause pain when walking or standing. It is often associated with other forms of fibromatosis like Dupuytren disease and Peryonie disease. Diagnosis is clinical and treatment involves conservative measures or surgical excision of the plantar fascia, depending on the size. 

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Related links

Anatomy of the foot
Anatomy clinical correlates: Foot
Penile conditions: Pathology review

Resources for research and reference

De Haan A, van Nes JGH, Werker PMN, Langendijk JA, Steenbakkers RJHM. Radiotherapy for patients with Ledderhose disease: long-term effects, side effects and patient-rated outcome. Radiother Oncol. 2022;168:83-88. doi:10.1016/j.radonc.2022.01.031

Fuiano M, Mosca M, Caravelli S, et al. Current concepts about treatment options of plantar fibromatosis: A systematic review of the literature. Foot Ankle Surg. 2019;25(5):559-564. doi:10.1016/j.fas.2018.06.001 

S SS, Thygarajan U, Raj DG, Susruthan M. Ledderhose disease: Pathophysiology diagnosis and management. J Orthop Case Rep. 2019;9(2):84-86. doi:10.13107/jocr.2250-0685.1384

Yun DH, Bonaroti AR, Lin KY. Ledderhose disease with concomitant presence of Dupuytren contracture: A case report and review of the literature. Plast Surg Case Stud. 2020;6. doi:10.1177/2513826x20903501