Dr. Ed Davis
Dr. Ed Davis is a Board Certified Podiatrist practicing in the Stone Oak area of San Antonio.
He is a graduate of the Temple University School of Podiatric Medicine in Philadelphia and completed a podiatric surgical residency at the Veterans Administration Medical Center in Washington, DC in 1983.
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:
1) The nodules can start as small pea size nodules but gradually increase in size to marble shaped or larger lesions.
2) The lesions are benign. The term “fibroma” refers to a growth consisting of fibrous or scar tissue.
3) Patients can have multiple lesions.
4) The fibromas can occur on one or both feet.
5) There are similarities to another disease process in the hand known as Dupuytrens Contacture.*
6) The nodules appear to be composed of fibrous tissue or aggressive scar tissue.
7) The lesions, when surgically removed, have a high recurrence rate.
8) 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.
Collagen is the main component of connective tissues in the body and is a structural protein. There are 28 types of collagen identified so far but 5 types are common in the body. Type 1 collagen is the main component of body tissues and is the main component of skin, hair, tendon and bone. Type 2 collagen is the main component of cartilage. Type 3 collagen, also called “reticulate” collagen is found in organs and often alongside type 1 collagen. Fibromas, the lesions of plantar fibromatosis show a high percentage of type 3 collagen and an abundance of fibroblasts, the cell associated with production of fibrous or scar tissue.
Type 3 collagen plays in important role in wound healing and tissue repair. The body reacts to damaged tissue in three phases. The first phase of wound healing involves hemostasis (reducing bleeding) followed by influx of cells (macrophages) which assist in the removal of damaged tissue and other cells involved in control of infection and the initiation of tissue repair. The second phase, the proliferative phase involves fibroblasts entering the wound and the production of scar tissue for the purpose of contracting the wound, the scar or fibrous tissue having a high percentage of type 3 collagen. The final phase of wound healing, the maturation phase, involves the replacement of type 3 collagen with type 1 collagen.
The formation of the thick fibrous nodules of plantar fibromatosis (Ledderhose disease) represents a localized defect in modulation of the healing process in that excessive scar tissue is deposited and not replaced with normal tissue. Considering this defect in the healing process, avoidance of procedures which cause tissue damage, ie. Surgical treatment, is an important consideration.
The term, “plantar fibromatosis” has been used more commonly in the US, while “Ledderhose disease,” more commonly in Europe. Both terms refer to the same disease. The German physician, Georg Ledderhose, first described the disorder in 1897.
Plantar fibromatosis is generally considered a rare disease, occurring more commonly in men than women, rarely in children and more commonly in Caucasians. Ledderhose disease is associated with conditions such as Duypuytren’s contracture which demonstrates similar, but not identical, lesions in the hand. Other related conditions include penile fibromatosis or Peyronies disease. It is important to consider such conditions as they show a similar underlying defect in the laying down of abnormal collagen despite appearing on different areas of the body. Considering the relatively low volume of information and research on plantar fibromatosis, reading the literature about related conditions can provide valuable insights to treatment.