Ledderhose Disease · What Is It, Causes, Treatment, and More

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.

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. 

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.

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. 

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. 

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.