Ledderhose disease is a benign growth of connective tissue in the sole of the foot. The disease belongs to the fibromatoses.
What is Ledderhose disease?
In Ledderhose disease, also known as Ledderhose disease, connective tissue proliferates in the sole of the foot. Hardened knots form that cause pain and limit the mobility of the foot. The disease manifests itself in the plantar aponeurosis (tendon plate of the sole of the foot). See homethodology for Mineral Deficiency Overview.
Morbus Ledderhose is assigned to the fibromatoses. In addition, there is a relationship with Dupuytren’s disease. While Ledderhose’s disease affects the soles of the feet, this is the case with Dupuytren’s disease on the palms of the hands. The benign disease was named after the German physician Georg Ledderhose (1855-1925), who described it.
Ledderhose disease occurs twice as often in men as in women. The condition involves slow growth of nodules that are concentrated in the center of the sole of the foot. Sometimes the growth of the nodules can also be delayed, so that they temporarily no longer enlarge. Later, their growth then starts again and unexpectedly.
Causes
Ledderhose disease is caused by an increase in connective tissue. However, the causes of Ledderhose disease that trigger the growths are not known. The myofibroblasts, which are special cells, are responsible for the proliferation of connective tissue. The exact connections are still being researched in medicine.
Various scientists assume the influence of a genetic component in the development of Ledderhose’s disease. If injuries then occur on the sole of the foot, the changes in the connective tissue are caused by genetic factors. In addition, the disease often runs in families, which increases the likelihood of genetic influences.
Another significant risk factor is the presence of other fibromatoses such as Dupuytren’s disease. Diseases such as epilepsy or diabetes (diabetes mellitus) are also possible triggers. The contributing factors also include liver and metabolic diseases, stress and the consumption of alcohol and tobacco.
Symptoms, Ailments & Signs
Morbus Ledderhose is noticeable on the tendon plate of the sole of the foot. Nodes form there and harden. When the knots reach a certain size, they make it difficult for the patient to walk. They are usually located in the middle of the sole of the foot on the arch of the foot.
While some people only develop a single lump, others have more of them. Even whole strand formations are possible. If the knots spread over the entire sole of the foot, they grow together with the muscles and the skin that is over them. However, there are also milder forms of Ledderhose disease, in which only a small part of the plantar tendon plate is affected.
In addition, there are no adhesions to the muscles and skin. About a quarter of all patients suffer from Ledderhose’s disease on both feet. It is not uncommon for the disease to progress in phases, so that it can take years to progress.
Diagnosis & course of disease
To diagnose Ledderhose’s disease, the doctor first interviews the patient. He or she finds out about possible previous illnesses and whether certain risk factors are present. A thorough examination of the soles of the feet is then carried out. Other areas of the body are also checked for any abnormalities.
Hard knots are a typical indication. These can hardly be moved by hand. Imaging techniques are used to determine the extent of the nodules. This includes first and foremost a sonography (ultrasound examination). Furthermore, a nuclear spin tomography (MRT) can be carried out, with which the exact spread of the nodules can be recorded.
The diagnosis is confirmed by examining the nodules with a microscope. For this purpose, a tissue sample (biopsy) is taken from the patient. Morbus Ledderhose is one of the benign chronic diseases. A complete cure is not possible. With appropriate treatment, however, it is possible to eliminate or at least reduce the symptoms.
Complications
Those affected by Ledderhose’s disease suffer from various complaints, which mainly occur on the soles of the feet. The patients suffer from restricted mobility and above all from pain that occurs when standing and walking. The quality of life of those affected is significantly restricted and reduced by Ledderhose’s disease. Other muscles can also be affected by this disease.
However, the symptoms often do not appear permanently, but in phases, so that the disease is only diagnosed at a late stage. Sudden movement restrictions often cause those affected to suffer from depression or mental health problems. In children, Ledderhose’s disease can lead to developmental disorders and possibly delay them.
A causal treatment of Morbus Ledderhose is unfortunately not possible. For this reason, the treatment is primarily aimed at reducing the pain and restricted movement. Complications usually do not arise. With the help of various therapies and the use of medication, many complaints can be limited so that those affected can go about their normal everyday lives. However, Ledderhose’s disease can also occur again. However, the life expectancy of the patient is not affected by this disease.
When should you go to the doctor?
If a hard, immovable lump is noticed in the foot, a doctor should be consulted. However, it does not have to hide a Morbus Ledderhose behind it. The contact person for pain or new knots in the foot is the orthopedist. The family doctor can also look at the foot and, if necessary, refer the affected person to a specialist.
If the diagnosis is unclear, magnetic resonance imaging can be ordered if Ledderhose disease is suspected. To confirm the diagnosis, the doctor may take a biopsy to further examine the lump. The nodule’s benignity must be determined.
Regular visits to the doctor are normal if you have Ledderhose disease. Unfortunately, surgical treatment often leads to recurrences. It is therefore mostly avoided. The frequently prescribed therapeutic approaches slow down the spread of the nodular tissue. Special insoles can have a pressure-reducing effect on benign fibromatoses. How often a visit to the doctor is indicated to adjust the therapeutic measures depends on the severity of the growths.
The ulcers can be irradiated. Physiotherapeutic treatments are also possible for Morbus Ledderhose. All therapeutic measures can at best slow down the formation of knots. There is currently no cure in sight for the diagnosis of Ledderhose’s disease.
Treatment & Therapy
One of the most important goals in the treatment of Ledderhose’s disease is to reduce inflammation and pain. In addition, the patient should be able to walk again. Soft insoles are usually used to maintain the ability to walk. These reduce the internal pressure that arises on the knots.
To treat the pain, the doctor usually administers non-steroidal anti-inflammatory drugs (NSAIDs) to those affected, which also have an effect on the inflammation. At the same time, steroid injections are given into the nodes.
In the early stages of Ledderhose’s disease, radiotherapy using soft X-rays is also considered promising. The injection of collagenases or shock wave therapy (ESWT) are also classified as useful. These lead to loosening of the hard knots. Cryotherapy, in which the doctor treats the patient with cold, is also seen as promising.
If the stage is already advanced, surgical intervention may be necessary. It is not uncommon for the complete removal of the tendon plate to take place. In contrast, partial interventions often lead to a recurrence of nodes. However, even with a complete removal of the plantar fascia, there is a risk of renewed fibromatosis in around 25 percent of all patients. In addition, injuries to tendons, nerves and muscles can occur during the operation.
Outlook & Forecast
Ledderhose’s disease typically takes a relapsing course over several years. Nevertheless, the prognosis is very good. It is usually sufficient to remove the affected fascia and eliminate the trigger of Ledderhose’s disease. X-ray treatment involves exposure to radiation, which can sometimes cause physical symptoms. Since mainly soft X-rays are used in the treatment of Ledderhose’s disease, the risk of serious side effects is relatively low. The use of collagenase or shock wave therapy is also unproblematic and promising.
The prognosis is positive when the condition occurs as a side effect of drugs such as primidone or phenobarbital. It is usually sufficient to stop the triggering medication. Life expectancy is not affected by Ledderhose’s disease. However, the quality of life can be reduced during the time of the disease, since the feet are very painful and the patient can hardly step on the soles without feeling intense pressure pain. Especially in the acute phase of the disease, this can lead to severe symptoms and limitations in everyday life. The general practitioner or podiatrist can make a reliable prognosis, taking into account the cause of the condition and the constitution of the patient.
Prevention
It has not yet been possible to determine how Ledderhose disease develops. For this reason, no preventive measures are known.
Aftercare
Medical aftercare for Morbus Ledderhose is only necessary if an operation is performed. Otherwise there are no follow-up measures. Drugs that act symptomatically or other non-surgical treatment measures never make follow-up care necessary. In some cases, treatment is not even given due to an acceptable level of suffering.
If an operation is carried out to remove the hardened tissue from the soles of the feet, a number of follow-up measures must then be taken into account. This can be explained by the fact that the feet are already under a lot of strain in everyday life. Proper healing of the wounds and scars is made considerably more difficult.
In addition to a very pronounced protection of the feet, which can be achieved by the patient by not walking and standing, special attention must be paid to wound hygiene. Keeping it clean and protecting from sweat makes healing easier and prevents infection.
Depending on the extent of the operation, the responsible specialist must work out an appropriate healing plan with the patient. After a few weeks, when the soles of the feet have healed, the feet can gradually be loaded again. The extent to which this should be done gradually also depends on the scope of the operation. If only individual nodules are removed, the sole is less affected than with a complete fasciectomy.
You can do that yourself
Since Morbus Ledderhose cannot be cured, patients must learn to come to terms with the disease in the long term. In some cases it is advisable to seek psychological help in addition to medical treatment. In addition, those affected can exchange ideas in various Internet forums for self-help. In larger cities there are also self-help groups for people who suffer from Ledderhose disease or fibromatosis in general. There you will also find more detailed information on self-help measures.
It is also important to take care of your feet regularly and to avoid injuries. Irritation of the soles of the feet should be avoided. When buying shoes, make sure that the shoes fit well. If necessary, those affected should resort to orthopedic custom-made products or use insoles. In some cases, walking barefoot regularly over soft surfaces such as grass, sand or mud helps. Cooling and gentle massages can also lead to improvement or prevent deterioration.
It is also advisable to change your diet and reduce your intake of glucose and carbohydrates. Foods that contain many natural antioxidants have a supporting effect. It is therefore advisable to eat as much fruit and vegetables as possible, but also legumes. Alcohol and coffee can usually still be consumed in moderation.
