Ledderhose disease

Información en español Title

Other Names:

Lederhose disease

Categories:

Rare Cancers; Skin Diseases

Summary Summary

Ledderhose disease is a type of plantar fibromatosis characterized by the growth of hard and round or flattened nodules (lumps) on the soles of the feet.^[1] It is generally seen in middle-aged and elderly people, and affects men approximately 10 times more often than it affects women. It typically affects both feet and progresses slowly, but not indefinitely.^[1] The nodules are typically painless at first, but may cause pain when walking as they grow.^[2] Often, people with Ledderhose disease also have other conditions associated with the formation of excess fibrous connective tissue such as Dupuytren contracture, knuckle pads, or Peyronie disease. Repeated trauma, long-term alcohol consumption, chronic liver disease, diabetes, and epilepsy have also been reported in association with this condition. The exact cause of Ledderhose disease is not known, but heredity is thought to play a role in many cases.^[1] Treatment, if needed, involves conservative management, steroid injections, radiotherapy, and surgery (plantar facia removal (fasciectomy) and surgical removal of of the fibrous tissue. The condition has a good prognosis, although slow progression is not uncommon. Fasciectomy has been shown to reduce the rate of recurrences.^[1]^[3]

Last updated: 9/8/2017

Symptoms Symptoms

The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below.

Signs and Symptoms	Approximate number of patients (when available)
Arthralgia	Very frequent (present in 80%-99% of cases)
Lack of skin elasticity	Very frequent (present in 80%-99% of cases)
Paresthesia	Very frequent (present in 80%-99% of cases)
Subcutaneous nodule	Frequent (present in 30%-79% of cases)

Last updated: 9/1/2017

Treatment Treatment

The treatment options are conservative management, steroid injections, radiotherapy, and surgery. Initial treatment approach may involve regular (monthly or less often) glucocorticoid injection and soft shoe inserts with cutouts for the nodules.^[4] Conservative treatment and steroid injections are options for painless and early painful stages. However, the node's reduction or further relapses after healing are inevitable with only conservative therapies and without surgery.^[5]^[6] When conservative treatments fail to reduce the symptoms, surgery is indicated.

There are three types of surgery: local, wide, and complete fasciectomy.^[3] Recurrence following surgery is common.^[4]

Treatment options that have being reported in a few cases (no single treatment seem to be effective in all cases) include:^[3]^[1]^[6]^[7]^[8]

Radiation therapy: This treatment may stop the disease progression in the initial stage and can dissolve small nodules. In progressed stages with large nodules radiotherapy can shrink nodules in size and relief pain. Radiation therapy is also applied if surgery cannot be repeated anymore due to excessive scar tissue.
Cortizone injections: For some patients this treatment may be able to decrease the size and the pain.
Collagenase injection: Collagenase is used for treating Dupuytren contracture. Initial trials are being done to evaluate whether this treatment can be used for Ledderhose disease as well.
Cryotherapy (cryosurgery): Cryotherapy is a potentially promising therapy for Ledderhose disease.
Massaging: A few patients reported that intense massaging over the lesions helped reducing the nodule size and relieved pain. It is unclear whether this would work for everyone and this is not an established therapy.
Needle aponevrotomy (NA): Can be useful if the toes are contracted. As this is often not the case and the problems arise rather due to the size of the nodule and its inflammation, NA is rarely applied for Ledderhose disease.
Shock waves: Have being done in some cases and may be able to soften Ledderhose nodules and reduce pain in some cases.
N-Acetyl-L-Cysteine: It is used for Dupuytren's disease but had shown some good results for Ledderhose, however, it is not tested with a larger number of a patients.

The International Dupuytren Society provides further information on treatment options for Ledderhose disease at the following link:
http://www.dupuytren-online.info/ledderhose_therapies.html

We strongly recommend that you review this information with your healthcare providers. Only a healthcare provider can help you make decisions regarding which treatment approach may be best for you.

Last updated: 9/1/2017

Do you have updated information on this condition? Let us know.

Research Research

Research helps us better understand diseases and can lead to advances in diagnosis and treatment. This section provides resources to help you learn about medical research and ways to get involved.

Clinical Research Resources

ClinicalTrials.gov lists trials that are studying or have studied Ledderhose disease. Click on the link to go to ClinicalTrials.gov to read descriptions of these studies.

Please note: Studies listed on the ClinicalTrials.gov website are listed for informational purposes only; being listed does not reflect an endorsement by GARD or the NIH. We strongly recommend that you talk with a trusted healthcare provider before choosing to participate in any clinical study.

Organizations Organizations

Support and advocacy groups can help you connect with other patients and families, and they can provide valuable services. Many develop patient-centered information and are the driving force behind research for better treatments and possible cures. They can direct you to research, resources, and services. Many organizations also have experts who serve as medical advisors or provide lists of doctors/clinics. Visit the group’s website or contact them to learn about the services they offer. Inclusion on this list is not an endorsement by GARD.

Organizations Supporting this Disease

Dupuytren Foundation
1850 Forest Hill Blvd STE 201
West Palm Beach, FL 33406-6064
Telephone: 561-429-8279
Fax: 561-828-0494
Website: https://dupuytrens.org
International Dupuytren Society
Westerbuchberg 60b
Uebersee, 83236 Germany
E-mail: http://www.dupuytren-online.info/contactform.html
Website: http://www.dupuytren-online.info/index.html

Social Networking Websites

Visit the following Facebook groups or pages related to Ledderhose disease:
Dupuytren's Disease Support Group DDSG

Do you know of an organization? Send us your suggestions.

Learn More Learn More

These resources provide more information about this condition or associated symptoms. The in-depth resources contain medical and scientific language that may be hard to understand. You may want to review these resources with a medical professional.

In-Depth Information

Medscape Reference provides information on this topic. You may need to register to view the medical textbook, but registration is free.
The Monarch Initiative brings together data about this condition from humans and other species to help physicians and biomedical researchers. Monarch’s tools are designed to make it easier to compare the signs and symptoms (phenotypes) of different diseases and discover common features. This initiative is a collaboration between several academic institutions across the world and is funded by the National Institutes of Health. Visit the website to explore the biology of this condition.
Orphanet is a European reference portal for information on rare diseases and orphan drugs. Access to this database is free of charge.
PubMed is a searchable database of medical literature and lists journal articles that discuss Ledderhose disease. Click on the link to view a sample search on this topic.

News & Events News & Events

News

Don’t Miss the NCATS Toolkit for Patient-Focused Therapy Development Event
August 31, 2017
Funding Opportunities Now Available for the Undiagnosed Diseases Network (UDN) Phase II
August 30, 2017
IRDiRC Goals 2017-2027: New Rare Disease Research Goals for the Next Decade
August 10, 2017

GARD Answers GARD Answers

Questions sent to GARD may be posted here if the information could be helpful to others. We remove all identifying information when posting a question to protect your privacy. If you do not want your question posted, please let us know. Submit a new question

I have Ledderhose disease and Dupuytren's contracture. I also have a family history of these conditions. My condition has worsened despite multiple surgeries. Is there a satisfactory treatment for Ledderhose? See answer
Is there any research being done regarding a possible association between a history of diabetes and a diagnosis of Ledderhose disease? See answer

Have a question? Contact a GARD Information Specialist.

References References

Hougeir FG. Plantar Fibromatosis. Medscape Reference. June 3, 2016; http://emedicine.medscape.com/article/1061903-overview.
Ledderhose disease. International Dupuytren Society. December 28, 2016; http://www.dupuytren-online.info/morbus_ledderhose.html.
Akdag O, Yildiran G, Karamese M & Tosun Z. Dupuytren-Like Contracture of the Foot: Ledderhose Disease.. The Surgery Journaloi:10.1055/s-0036-1593355.. 2016; 2(3):102-104. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5553473/.
Sheon RP, De Keyser F. Ganglia and nodules. In: Basow DS. UpToDate. Waltham, MA: UpToDate; 2013;
Kan HJ, Hovius SE. Long-term follow-up of flaps for extensive Dupuytren's and Ledderhose disease in one family. J Plast Reconstr Aesthet Surg. 2012 Dec;65(12):1741-5; http://www.ncbi.nlm.nih.gov/pubmed/22917697.
Therapies for Ledderhose's disease (Plantar fibromatosis or Morbus Ledderhose). International Dupuytren Society. 2016; http://www.dupuytren-online.info/ledderhose_therapies.html.
Watt AJ, Curtin CM, Hentz VR. Collagenase injection as nonsurgical treatment of Dupuytren's disease: 8-year follow-up. J Hand Surg Am. 2010 Apr;35(4):534-9, 539.e1; http://www.ncbi.nlm.nih.gov/pubmed/20353858.
van Rijssen AL Werker PM. Treatment of Dupuytren's contracture; an overview of options. Ned Tijdschr Geneeskd. 2009;153:A129; http://www.ncbi.nlm.nih.gov/pubmed/19857298.