References and Links on Ledderhose Disease or Plantar Fibromatosis

One of the more comprehensive and balanced articles on the treatment of plantar fibromatosis.

Article in the Journal, Podiatry Today by Matt Sabo, DPM discusses the nature of plantar fibromatosis, imaging and some treatments.

Article advocating surgical treatment due to the supposed “non-effectiveness” of conservative treatments. Little consideration is provided to the diversity of conservative treatments.

Section on Ledderhose Disease from the International Dupuytren Society.

This is one of the more complete online discussions yet there is omission of a number of non-invasive and minimally invasive modalties such as TenexTX, Topaz procedure and use of the enzyme, hyaluronidase.

Ledderhose Disease BlogSpot by Gary Manley, a Ledderhose Disease sufferer who found success with radiation therapy.

A good discussion of plantar fibromatosis and imaging including good sonographic and MRI pictures. Limited discussion of non-invasive and minimally invasive treatments.

Staging or classification of plantar fibromatosis.

Grading system for plantar fibromatosis proposed by Sammarco.

Grade 1: -Focal disease isolated to a small area on the medial or central aspect of the plantar fascia.

-No adherence to skin

-No deep extension to flexor sheath (underlying tendon)

Grade 2: -Multifocal disease, with or without proximal or distal extension

-No adherence to skin.

-No deep extension to flexor sheath.

Grade 3:  -Multifocal disease with or without proximal or distal extension

-Either adherence to the skin or deep extension to flexor sheath present

Grade 4:  -Multifocal disease, with or without proximal or distal extension

-Adherence to the skin

-Deep extension to the flexor sheath

Imaging of plantar fibromatosis. and

Surgical excision of plantar fibromas. The photos indicate a wide excision.

A paper advocating radiotherapy for Ledderhose disease. and which presents radiotherapy as an alternative to surgical treatments yet without mention or comparison to conservative and minimally invasive treatments.

Potential side effects of radiation therapy This is a general list. It would be expected that radiotherapy applied in a highly focused area such as the foot would lessen such risks. Also

There may be no literature on the long term effects of radiotherapy on Ledderhose disease due to the relative rarity of the disease. The most relevant literature to study is that which discusses the long term effects on skin and wound healing. and

Brief discussion of effects of radiotherapy for Duypuytrens.

histologic study which asserts that Ledderhose Disease and Dupuytren’s contracture “are expressions of the same disorder.”

An explanation of the rationale behind use of topical Verapamil for Ledderhose disease.

Aluisio FV, Mair SD, Hall RL (1996) Plantar fibromatosis: treatment of primary and recurrent lesions and factors associated with recurrence. Foot & Ankle Int 17:672–678

Aviles E, Arlene M, Miller T (1971) Plantar fibromatosis. Surgery 69:117–120

Lee TK, Wapner KL, Hecht PJ (1993) Current concept review: plantar fibromatosis. J Bone Joint Surg 75A:1080–1083

Interesting case report in which an oral retinoid appeared to be of benefit.

Orthotic modifications for plantar fibromatosis. Larry Huppin, DPM discusses how orthotics may be modified to increase effectiveness in patients with plantar fibromatosis:

Emerging research on plantar fibromatosis and plantar fasciitis:

Treatment of plantar fibromatosis utilizing the TenexTX Fast procedure:

Austin Journal of Orthopedics and Rheumatology: Patel MM, Patel SM, Patel SS and Daynes J. A Pilot Study of a Novel Treatment Method for Refractory Painful Plantar Fibromas. Austin J Orthopade & Rheumatol. 2015;2(2): 1014. Eight patients from 2011 to 2104 underwent treatment via the Tenex equipment with good results.

A good article discussing the mechanism of action of hyaluronidase, the enzyme which successfully reduces the nodules of plantar fibromatosis: