)
Ledderhose Disease, also known as Plantar Fibromatosis or Morbus Ledderhose is a disease in which painful hard nodules form on the bottom of the foot.
Ledderhose Disease or Plantar Fibromatosis is a disease process in which the body forms hard nodules or fibromas on the bottom of the foot, attached to the plantar fascia, the ligament spanning the arch. The nodules are composed of fibrous (scar) type tissue. It is classified as a “hyperproliferative” disorder, that is, a disorder where there is an overgrowth of tissue. The cause of this disease is not known but there are a number of known characteristics:
- The nodules or fibromas can start as small pea size nodules but gradually increase in size to marble shaped or larger lesions.
- The lesions are benign. The term “fibroma” refers to a growth consisting of fibrous or scar tissue.
- Patients can have multiple lesions.
- The fibromas can occur on one or both feet.
- There are similarities to another disease process in the hand known as Dupuytrens Contracture.*
- The nodules appear to be composed of fibrous tissue or aggressive scar tissue.
- The lesions, when surgically removed, have a high recurrence rate.
- The incidence of Ledderhose Disease compared to Dupuytrens is relatively low so there is a paucity of research and literature on the subject. Lack of knowledge about the problem may often lead to limited availability of treatment options. . Ledderhose Disease is considered rare but, unfortunately, has not been adequately tracked.
- The underlying cause is genetic. There is a local defect in the healing mechanism in response to tissue injury in which scar tissue is produced in excess and not broken down properly. This is why surgical treatment can “provoke” the growth of more fibromas.
- Diagnosis is primarily by clinical exam. Sonography or diagnostic ultrasound generally provides the best images of fibromas.
- Fibromas in the arch of the foot are superficial to the plantar fascia, the ligament supporting the midfoot. If imaging shows a lesion deep to the fascia, it is probably not a fibroma.
- Fibroblasts are the cell type that create scar tissue and fibromas. The problematic fibroblasts appear to emanate from the extracellular matrix (ECM) so targeting this tissue is the key to effective treatment.