Ledderhose disease is characterized by the appearance of benign tumors in the arch of the foot. This disease can remain silent but can also be manifested by pain and discomfort when walking. Management depends on the impact of the disease on a daily basis.

Definition of Ledderhose disease

Ledderhose disease is plantar fibromatosis, which is a type of superficial fibromatosis that occurs in the arch of the foot. Fibromatosis is characterized by the appearance of fibroids, benign tumors with proliferation of fibrous tissue.

In the case of Ledderhose disease, tumor development takes place in the form of nodules. In other words, we can see a rounded and palpable formation under the skin at the level of the plantar aponeurosis (fibrous membrane located on the plantar surface of the foot and extending from the heel bone to the base of the toes).

Ledderhose disease usually affects both feet. Its evolution is slow. It can extend over several years.

Causes of Ledderhose disease

The causes of plantar fibromatosis remain poorly understood to this day. It would seem that its development could be due, favored or accentuated by:

• a hereditary genetic predisposition which seems to be present in 30% to 50% of cases;
• the existence of diabetes;
• alcoholism;
• taking certain medications, including isoniazid and barbiturates;
• micro-traumas, such as those present in athletes;
• fractures in the foot;
• surgical procedures in this region.

People affected by Ledderhose disease

Ledderhose disease usually appears after 40 years of age and primarily affects males. Between 50 and 70% of those affected are men.

Ledderhose disease has been found to be often associated with two other forms of fibromatosis:

• Dupuytren’s disease, which corresponds to palmar fibromatosis with the development of tumors in the hand;
• Peyronie’s disease which corresponds to fibromatosis localized in the penis.

Ledderhose disease is more often associated with Dupuytren’s disease than with Peyronie’s. Among those affected by Ledderhose disease, it is estimated that around 50% of them also have Dupuytren’s disease.

Ledderhose Disease Diagnosis

The diagnosis is based primarily on a clinical examination. The doctor assesses the perceived symptoms and palpates the plantar region. This palpation shows the formation of nodules characteristic of the development of Ledderhose disease.

To confirm the diagnosis, the healthcare professional may order medical imaging tests, such as an ultrasound or MRI (magnetic resonance imaging).

Plantar nodules

Ledderhose disease is characterized by the progressive development of nodules in the arch of the foot. Firm and elastic, these nodules are palpable under the skin. They are usually located in the central portion of the arch of the foot.

Note: the appearance of nodules may be asymptomatic, without obvious clinical manifestation.

Pain and discomfort

While Ledderhose disease can be silent, it can also cause pain and discomfort when moving around. Severe pain can occur and make it difficult to walk, run and put your foot on the ground in general.

No treatment in some cases

If Ledderhose disease does not cause discomfort or pain, no specific management is required. Regular medical monitoring is in place to assess the progression of the disease and identify the appearance of inconvenience as early as possible.

Kinésithérapie

In case of pain and discomfort when walking, massages and extracorporeal shock wave sessions may be considered.

Orthopedic sole

Wearing plantar orthotics (orthoprostheses) may be suggested to limit pain and discomfort.

Medical treatment

Local corticosteroid therapy can also be used to relieve pain.

Surgical treatment

If Ledderhose disease causes significant functional impairment, the placement of an aponeurectomy may be discussed. This is a surgical procedure that involves cutting the plantar fascia. Performed under local anesthesia, the aponeurectomy can be partial or total depending on the case.

The surgery is followed by rehabilitation sessions.

The etiology of Ledderhose disease remains poorly understood to this day. Prevention consists of combating preventable factors that can promote or accentuate its development. In other words, it may in particular be advisable to:

• wear suitable shoes;
• maintain a healthy and balanced diet;
• engage in regular physical activity.