Nutrition and Ledderhose Disease

There is limited data about the response of Ledderhose Disease or Plantar Fibromatosis. One must cast a larger net to acquire information on this subject. Plantar fibromatosis is a disorder in which excessive fibrosis or scar tissue is created by the body in response to a stimulus. The exact stimulus is unknown but may be due to chronic repetitive strain or stress on the plantar aponeurosis. Microtears occurring in the plantar aponeurosis or fascia may heal with excessive fibrosis in a similar fashion to a keloid forming in a skin cut. Skin wounds may heal normally, forming a linear scar. Skin wounds may heal with a hypertrophic scar in which the wound is thick and “knot” like due to excessive deposition of scar tissue. Skin wounds may heal with a keloid in which the scar hypertrophy extends beyond the original wound margins. Processes occurring in keloid formation, plantar fibromatosis, Ledderhose disease and Peyronie’s disease are analogous in that there is a defect in scar tissue modulation.

The goal is to look at the overall process, the fault in scar tissue modulation. Formation of scar tissue is a normal response to healing. A wound requires formation of fibrosis or scar tissue in order to contract, bring the wound edges together. The body need create the right amount of scar tissue at the right time. Once the scar forms, it undergoes remodeling, that is reduction in size and softening.

Specificity is the key to effective treatment. If there is a disorder of fibrosis, then target the fibrosis, not the good tissue. That is the reason why use of enzymes that target fibrosis specifically is logical. Surgery is trauma and trauma to an area of the body that cannot repair trauma correctly is a recipe for failure. Radiotherapy is more specific that surgery but, again, is nonspecific, being destructive to all tissue in its path.

The following is a discussion of some nutritional approaches to the issue of excessive fibrosis. Research in this area may be limited but, most of the nutritional approaches are relatively safe.

Vitamin D.


The authors discuss vitamin D as a “novel therapeutic approach for keloid.”

Vitamin D and systemic sclerosis.

Vitamin D has also been suggested as a supplement that may assist with limiting the adverse affects of radiation exposure for those considering radiation therapy:

Vitamin E.

Role of vitamin E and pentoxifylline in treatment of radiation induced fibrosis. This may be a consideration for patients who have had radiotherapy for Ledderhose disease with the complication of hard, painful fibrotic skin.

Vitamin C.

Vitamin C has a well recognized role in collagen formation.

Vitamin C and fibrosis.

An interesting discussion of the role of fibroblasts, the cells which create fibrosis.

N-acetylcysteine (NAC)

There are websites suggesting supplementation with N-acetylcysteine. N-acetylcysteine has a role in the treatment of pulmonary fibrosis. Information concerning the potential effect of NAC on skin and other tissue is limited. NAC also has applications to include acetominophen overdose and possibly treatment of flu. Here is a good overview: clinical applications.pdf

NAC and melanoma.

EGCG or epigallocatechin-3-gallate

EGCG is found in teas and belongs to a class of antioxidants known as polyphenols.

Potential effect on systemic sclerosis.

Keloids and EGCG.

PABA or para-aminobenzoic acid

PABA is also known as 4-aminobenzoic acid is sometimes considered part of the B family of vitamins. A potassium salt of PABA is marketed as “POTABA” and is used in the treatment of Peyronnies disease.

Oral enzymes

Can oral enzymes have an effect on areas of fibrosis?