Plantar fibromatosis, Ledderhose disease
What is Ledderhose Disease?
It is a benign disease occurring more frequently in men over 40 years and is a fibromatosis of the sole of the foot. It is a sort of equivalent at the foot of Dupuytren’s disease at the level of the hand, or Peyronnie’s disease at the level of the corpora cavernosa of the penis.
It consists of a subcutaneous development of formations adherent to the skin and the deep tissues in the form of “nodules” and / or “strings” elastic on the palpitation, which can become painful and lead to a deformation of the toes in flexion. Tin a very small number of cases , like a very severe forms or very evolutive forms, it may attract the foot to the medial side; that is to say in varus. From the superficial plantar aponeurosis, the nodules are located in front of the flexors of the toes. It is a benign proliferation of fibroblasts. Being able to remain long infra-clinical, and when symptoms appear, these consist of a sensation to walk on a foreign body. Clinically, the patient complains of pain in the plantar arch with difficulty walking and / or running, and sometimes the sensation of walking on a “foreign body”. It can be bilateral.
Are there any causes for this?
Yes these are some morphotypes, tight shoes, or a sporting activity or an extended standing position, some incriminating heels and narrow-toed shoes.
Healing disorder, disturbances of plantar sensitivity and recurrence, if the aponeurosis is not entirely excised.
A month in general, of which 3 weeks with shoe postoperative, the time of the healing, maximum 6 weeks with resumption of the sport, 8 weeks after.
Is it necessary to pass tests to confirm the diagnosis?
No, at least at the beginning. The diagnosis is essentially clinical. Functional exploration is useful only in progressive, painful or disabling forms and before a therapeutic decision. Ultrasound makes it possible to know the hypo-echogenic composition of the nodules and their situations in the aponeurosis. MRI will eliminate other diagnoses: plantar lipoma or cyst, and investigate the extent of lesions and in case of surgical decision, plan the approach and extent of gestures and / or surgical resections.
How is this disease treated?
In the absence of pain, therapeutic abstention and surveillance because there is small possibility of regression. Otherwise, as soon as clinical signs appear, medical treatment may be offered:
- Medical: Massage, NSAIDs, Analgesics, Insoles, Corticosteroid infiltrations;
- Surgical: in the event of failure of the conservative treatment,
- Under A local: needle fasciotomy in 2 to 3 separate 15-day sessions followed by Strapp for 3 to 4 days;
- In the open procedure : dorsal or plantar way, it allows the excision of the neuroma with a good rate of cure;
- Aneuropathy: Minimally invasive technique, using the bevel of the needle to sever the plantar aponeurosis.
- Dupuytren’s disease: nodule and ropes causing flexion of the 4th and / or 5th finger towards the palm of the hand
- Peyrone disease: fibrotic retraction of the corpora cavernosa of the penis
- Infraclinical: ie the appearance of nodules and cords without painful or functional signs or symptoms