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Ledderhose's Disease

Discussion in 'Gerontology' started by Jo BB, May 14, 2013.

  1. Jo BB

    Jo BB Active Member


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    I have a reasonably young women presenting with Ledderhouse Disease as a referral under Medicare. She has painful plantar nodules. Examination showed marked asymmetry with her lunge test and Jacks test. The poorer results on the more nodular foot. As part of her treatment I will be providing some heel raises and hallux wedging. What other treatment modalities should I be considering? Has anyone used other modalities such as laser or shock therapy?
    Thank you,
    Jo BB
     
  2. Jo BB

    Jo BB Active Member

    Re: Ledderhouse Disease

    Hi ,should read Ledderhose not Ledderhouse!
    OOps, Jo BB
     
  3. N.Knight

    N.Knight Active Member

    Re: Ledderhouse Disease

    I tend to use a full length EVA TCI with dells/scoops to accommodate the modules, I believe they have a very recurrence rate if removed ( I am sure one if the surgeons here can give you the stats) and I am not aware of any other validated therapies to reduce them.

    Some assessment details will help us as well.

    Nick
     
  4. Jo BB

    Jo BB Active Member

    Re: Ledderhouse Disease

    Thanks Nick. I also believe surgery is not an option,though I have just had one of my senior patients have surgery for his hallux contracture with the Dupuytren's. The only one in 27 years! I am going to trial improving her windlass action though, which is the chicken / egg conundrum.
    J0 BB
     
  5. Jara_fersa

    Jara_fersa Welcome New Poster

    Re: Ledderhouse Disease

    Hi,
    In addition what you are doing yo can also consider; infiltration of steroids that i think they are not much effective, the surgery option wich is complicate because of the chances that it can leave a scar. I have been reading about radiotherapy that i think is the best choice, it will stop the growth of the nodules, if they're small they can even disappear.
    Hope it proves to be helpful
     
  6. Admin2

    Admin2 Administrator Staff Member

    Re: Ledderhouse Disease

    Plantar fibromatosis

    Plantar fascial fibromatosis, also known as Ledderhose's disease, Morbus Ledderhose, and plantar fibromatosis, is a relatively uncommon[2] non-malignant thickening of the feet's deep connective tissue, or fascia. In the beginning, where nodules start growing in the fascia of the foot the disease is minor[citation needed]. Over time walking becomes painful. The disease is named after Dr. Georg Ledderhose, a German surgeon who described the condition for the first time in 1894.[3][4] A similar disease is Dupuytren's disease, which affects the hand and causes bent hand or fingers.

    As in most forms of fibromatosis, it is usually benign and its onset varies with each patient.[5] The nodules are typically slow growing[2][5] and most often found in the central and medial portions of the plantar fascia.[2] Occasionally, the nodules may lie dormant for months to years only to begin rapid and unexpected growth.[5] Options for intervention include radiation therapy, cryosurgery, treatment with collagenase clostridium histolyticum, or surgical removal only if discomfort hinders walking.[6]

    1. ^ "OMIM Entry - % 126900 - DUPUYTREN CONTRACTURE". www.omim.org. Retrieved 5 August 2017.
    2. ^ a b c Sharma S, Sharma A (2003). "MRI diagnosis of plantar fibromatosis—a rare anatomic location". The Foot. 13 (4): 219–22. doi:10.1016/S0958-2592(03)00045-2.
    3. ^ Ledderhose G (1894). "Über Zerreisungen der Plantarfascie". Arch Klin Chir. 48: 853–856.
    4. ^ "Dupuytren's contracture - Patient UK". Retrieved 2007-12-27.
    5. ^ a b c Bunion Busters. "Plantar fibromatosis". Retrieved 2007-12-27.
    6. ^ Flatt AE (2001). "The Vikings and Baron Dupuytren's disease". Proc (Bayl Univ Med Cent). 14 (4): 378–84. doi:10.1080/08998280.2001.11927791. PMC 1305903. PMID 16369649.
     
  7. drsarbes

    drsarbes Well-Known Member

    besides off loading, steroid injections, topical verapamil gel...not much out there that actually helps.
    In my experience, if the lesions are painful on ambulation and accommodative insoles fail to relieve the pressure, surgical excision is indicated.

    Steve
     
  8. Jo BB

    Jo BB Active Member

    Thank you for all the responses. I was surprised to see both on Wikipedia and the International Dupuytren's society a link with DM.
    Kind regards,
    Jo BB
     
  9. mgates01

    mgates01 Active Member

    I would certainly try off loading in the first instance. I attach a photo of a runner I treated with a plantar fibroma. I made her devices with a cut out for the fibroma (which I then filled with a poron and memory foam laminate). I year later she came back for a second pair and the fibroma had reduced considerably in size.
    Of course this is easier if you have just one nodule, if you have multiple that will prove more tricky. good luck
    Michael


    DSCF4072.jpg

    plantar nodule 004.jpg
     
  10. Jo BB

    Jo BB Active Member

    Thank you Michael,I am producing a device with apertures for the nodules and adding the hallux wedge and heel raise.My patient will be pleased to hear such good news about yours.We are also going to do an audit in regards to the DM and the Dupuytren's/Ledderhose in our practice. I have always mentioned it in the deformity risk factor part of the diabetic foot risk assessment as an aside but never thought there might be an association with either DM or plantar fasciitis.
    Thanks again,Jo
     
  11. Paul Bowles

    Paul Bowles Well-Known Member

    We are just collating data from some research done a while back on plantar fasciosis/plantar fascial tears and ultrasound. There seemed to be some relationship between plantar fibromas and plantar fasciosis. We discovered a significant proportion of plantar heel pain patients had fibromas on ultrasound diagnostics. As Michael above correctly points out they do change in size and we have them doing so on ultrasound in the same patient over several months - it would seem to be if they are not irritated they seem to change. I would be interested to see if the fibromas had a significant relationship to fasciosis - I assume they do. The better ultrasound diagnostics become the more we seem to find clinically (from very small and non palpable to very large like the one above).

    I would also assume that fibromas in the plantar fascia lead to tension issues within it - I recall reading an article a while back about a patient case series study where a surgeon in Scotland just happened to biopsy parts of fascia after a fasciotomy and all cases (I believe there were 6) had positive histopath for fibromas. If anyone has this study please let me know I would love to get my hands on the full copy. So it begs the question - chicken or egg - fibroma --> fasciosis --> intrasubstance tear? Or tear --> fasciosis --> fibroma ??
     
  12. Jo BB

    Jo BB Active Member

    Thanks Paul,this seems to be fitting in with the lunge test and delayed Jacks test result [worse on the nodular foot] with this patient and my initial treatment plan of treating it similarly to plantar fasciitis and why it may also be associated with DM.This study would be great to read.
    Cheers, Jo
     
  13. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Dupuytren-Like Contracture of the Foot: Ledderhose Disease.
    Akdag O et al
    Surg J (N Y). 2016 Sep 21;2(3):e102-e104. doi: 10.1055/s-0036-1593355.
     
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