Ledderhose disease corresponds to the appearance of fibrous nodules on the sole of the foot within the plantar aponeurosis. It evolves by inflammatory flare-ups.
What is Ledderhose disease?
Ledderhose disease is a fibrosis of the superficial plantar aponeurosis, also called plantar fibromatosis. The plantar fascia is a “thick and very sturdy fibrous web that attaches to the base of the heel and radiates to the base of the toes, explains Dr. Martin Schramm, orthopedic surgeon. Nodules may appear at the level of this fibrous sheet”. Ledderhose disease is thus characterized by theappearance of one or more nodules under the arch of the foot This is a rare pathology similar to Dupuytren’s disease in the hand.
What are the causes ?
“We don’t know why this fibrosis appears, it’s probably hereditary. But we know how it can evolve: by inflammatory flare-ups. The thrust results in an increased thickness at the level of the sole of the foot. When the push stops, either the nodule returns to its initial size, or it grows a little or we see the appearance of other nodules. The pain of the nodule depends on the area where it is located: it only hurts if it is in a support area.”
There is no natural treatment.
What tests to diagnose it?
The diagnosis is made on clinical examination. “If we want to get an idea of the extent of the nodules, we do an ultrasound to assess their size and location.”
What are the treatments for Ledderhose disease?
There is no treatment except surgery. However, doctors advise to:
- Do not touch the nodule. “As we don’t know what is causing the inflammatory flare-up, we prefer to advise against touching the nodule to avoid causing enlargement or flare-up.”
- Avoid wearing shoes that can press on the nodule;
- Avoid orthopedic insoles which fill hollow feet;
- Avoid heels causing pain: the higher the heel, the greater the arch and the more it can press on the nodule.
About the surgerythis is possible in case of pain or if the nodule is in an awkward area. “We carry out ultrasound identification to find out how long the nodule is, the area where it is located, if it is close to nerves or vessels… We then resect only the nodules that are symptomatic, we do not touch those that are side but without pain.” However, despite surgery, there is a risk of recurrence. Exceptionally, when the plantar aponeurosis is completely fibrous and nodular, it is possible to have recourse to a subtotal aponeurectomy, that is to say resecting almost completely the plantar aponeurosis. After removal of the nodule, “we immobilizes the foot thanks to a plaster sole in a shoe post-operative for three weeks then the patient is asked to walk with a post-operative shoe with immediate support with a rigid sole for another three weeks. The patient can put on sneakers and walk barefoot after a month and a half and resume any sports activity after three months. There is no natural treatment for Ledderhose disease.
What are massages for?
It is not advisable to perform a massage. “If people have no pain during a massage, they can continue, but if there is pain, you have to stop because it could cause inflammation.”
Which specialist to consult?
In case of Ledderhose disease, it is advisable to consult a orthopedic doctor.
Thanks to Dr. Martin Schramm, orthopedic surgeon.