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?
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. 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. When conservative treatments fail to reduce the symptoms, surgery is indicated.
There are three types of surgery: local, wide, and complete fasciectomy. Recurrence following surgery is common.
Treatment options that have being reported in a few cases (no single treatment seem to be effective in all cases) include:
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.