Ledderhose disease is a benign growth in the connective tissue of the soles of the feet. The disease belongs to the group of fibromatoses, connective tissue growths. The exact causes are unknown. With early treatment, the prognosis for the course of the disease is good.
You can find more information and recommended specialists for Ledderhose disease here.
Ledderhose disease usually appears on the soles of the feet without any recognizable trigger. Small nodules under the skin are conspicuous, which sufferers tend to discover by chance when shoes rub or are uncomfortable.
Ledderhose disease is a very massive, intermittent proliferation of connective tissue along the tendon plate of the sole of the foot. The exact cause is still unknown. However, the disease usually occurs suddenly and leads to palpable changes in the connective tissue (lump formation).
Currently, injuries to the sole of the foot or genetic predisposition are being discussed as possible causes. The latter is made more likely by the fact that Ledderhose disease can indeed run in families. As a rule, the disease also occurs about twice as often in men as in women.
Ledderhose disease is characterized by nodular protrusions under the skin along the tendon plate of the sole of the foot. These usually continue to grow and can be painful. In addition, the larger these nodules become, the more they interfere with walking.
This can lead to further complications, such as a reduced quality of life, which can also lead to depression. Nodules often cause pressure sores, which can become inflamed.
In Ledderhose disease, harmless but annoying lumps form on the sole of the foot @ Farantsa /AdobeStock
The doctor will start by taking a medical history. This provides initial indications for a suspected diagnosis. During the physical examination, the doctor then examines the feet, especially the soles of the feet.
Small and large indurations that are difficult or impossible to move indicate Ledderhose disease.
This is usually followed by a visualization of the feet with the nodule-bearing sole areas. With an ultrasound examination and an MRI, the doctor can get an idea of the number and size of the nodules.
In order to confirm the diagnosis of "Ledderhose disease", a histological examination of the nodules is carried out. The doctor therefore takes a tissue sample (biopsy). This also serves to rule out malignant cancer.
According to current understanding, Ledderhose disease is not curable. However, the restrictions and pain can usually be reduced, which gives those affected a great deal of quality of life.
In the early stages of the disease, doctors try to maintain the patient's ability to walk by using insoles or other orthopaedic aids. Non-steroidal anti-inflammatory drugs (NSAIDs) are used when patients feel pain or suffer from inflammation. Steroids can also be administered directly into the nodes to treat more severe inflammation.
Radiotherapy has been shown to be promising in the early stages. Soft X-rays irradiate the nodes directly. Shock wave therapy or cryotherapy are also suitable for treating Ledderhose disease.
Shockwave therapy for Ledderhose disease @ Dan Race /AdobeStock
At a more advanced stage, surgery is usually performed in which doctors remove the entire tendon plate. Partial procedures are less successful, as they usually contribute to recurrence.
Even if the tendon plate is completely removed, one in four patients suffers a recurrence, which means that the lumps reappear. Furthermore, surgical procedures on the foot are not without risks: Injuries to the nerves, muscles and tendons can cause consequential damage.
The relapsing nature of the disease ensures that there is no pressure to act in the early stages. Therefore, conventional treatment methods are always used first.
The disease progresses over several years with a good prognosis in most cases. It is often sufficient to remove affected tendons and fasciae. In this way, doctors may be able to remove the trigger for Ledderhose disease.
In rare cases, Ledderhose disease can be the result of a drug side effect. In this case, it is sufficient to discontinue the medication to reduce the symptoms.
The treatment of the disease and the care of those affected is interdisciplinary. This means that doctors from different specialist areas work together.
The aims of the treatment are
General practitioners, orthopaedists and surgeons are involved. In addition, non-physicians such as podiatrists (medical chiropodists) and physiotherapists provide support in the treatment and aftercare of Ledderhose disease.
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