Ledderhose Disease
Ledderhose disease is a condition affecting the soles of the feet and the plantar arch, with the appearance of one or more fibrous nodules within the plantar aponeurosis and the plantar fascia. At the Clinique du Pied, we can provide care for this painful condition, from diagnosis—including X-ray and ultrasound—to surgical treatment, as well as simple measures such as orthopedic insoles to prevent or reduce painful and inflammatory symptoms.
Symptoms of Ledderhose Disease
Ledderhose disease, also known as plantar fibromatosis, involves the appearance of firm fibrous nodules on the heel and arch, with varying locations and numbers, generally painless. Over time, these nodules may increase in size and number, become painful and inflamed, especially when located on weight-bearing areas near the calcaneus, making walking and wearing shoes uncomfortable.
It is important to note that heel pain is not always present and some patients may not experience any discomfort. The discovery of these nodules is then incidental, while massaging the sole of the foot or during a foot massage, for example. Symptoms depend on the shape of the foot, biomechanics, and patients’ footwear habits. This condition can be mistaken for other plantar conditions such as plantar fasciitis, heel spurs or Achilles tendonitis.
Impact on quality of life
The impact of Ledderhose disease on quality of life can be significant depending on foot shape, footwear habits, and the characteristics of the nodules. Difficulty walking and putting the heel down can limit daily activities, running, and sports. Heel pain is mainly related to the size, location under the heel, number, and extent of fibrous nodules, which cause excessive inflammation. Similar pain can be experienced in other conditions such as metatarsalgia affecting the forefoot and toes, or talalgia affecting the heel bone.
Causes of Ledderhose Disease
For effective management of a foot condition by a podiatrist, it is important to know the causes. However, the causes of Ledderhose disease are not known; it would appear that genetic factors and general factors may promote the development of this inflammatory condition. This disease affects the plantar aponeurosis, an important fibrous structure of the foot forming the fascia and the ligament under the foot.
Genetic factors
Ledderhose disease may be linked to a genetic predisposition affecting the fibrous tissues and the plantar membrane. In fact, some people may inherit genes that make them more likely to develop this disease with thickening of the fascia. However, it is important to note that the presence of these genes does not guarantee the onset of the painful disease; it simply increases the risk of injury and deformity.
General factors
In addition to genetic factors, general factors may also play a role in the development of Ledderhose disease, such as diabetes,overweight,obesity or excessive alcohol consumption.
There are associations between Ledderhose disease, or plantar fibromatosis affecting the soles of the feet, and Dupuytren’s disease, or palmar fibromatosis. Diabetes and alcoholism are also considered risk factors for Dupuytren’s disease, as are arthritis and joint problems in the lower limbs.
By learning about the factors that can lead to the onset of this disease and cause inflammation, it is possible to establish preventive measures including stretching and wearing appropriate insoles.
Ledderhose Disease Treatment
For painless or mildly symptomatic cases of Ledderhose disease, non-surgical treatment is offered to relieve pain. This may include plantar orthoses and orthopedic insoles to reduce pressure on the nodules and provide relief, physiotherapy exercises with a physical therapist to improve mobility and stretch the calf muscles, or shoe adaptations with heel pads and cushions to limit or avoid pressure on the nodules.
In some cases, cortisone or corticosteroid injections may be offered to reduce inflammation, as well as anti-inflammatory medications, massages, application of ultrasounds or shock waves for relief.
Surgical treatment
In some cases, surgery may be required to remove the Ledderhose fibrous nodules and cure the condition. Surgical treatment consists in surgically removing only the painful nodule(s), this is a selective partial aponevectomy allowing for recovery. Not all nodules are removed because the risk of recurrence after resection of the nodules is still possible, sometimes requiring an orthosis or a bandage in the postoperative phase.
When the aponeurosis is invaded by nodules with bony outgrowth such as a Lenoir’s heel spur, surgical resection of almost all of the aponeurosis may be proposed. This is then a subtotal aponevectomy, similar to the plantar aponeurosis surgery performed for other conditions such as fracture, tear, or muscle problems. All of the foot surgeries are performed at our clinic with expertise, including preoperative MRI and ultrasound follow-up.
Frequently Asked Questions about Ledderhose Disease
The question of a definitive cure is complex. As we explain in our detailed article "Is it possible to cure Ledderhose disease?", there is always a risk of recurrence, even after surgical treatment with injection and infiltration. That is why a personalized approach including stretching exercises, wearing appropriate shoes, and regular follow-up is essential to maintain recovery.
Ledderhose disease is characterized by fibrous nodules in the plantar aponeurosis and fascia, which distinguishes it from other conditions such as plantar fasciitis, which is an inflammation of this structure, heel spurs affecting the calcaneus, or flat foot problems with a collapsed arch. Differential diagnosis with X-ray is important to adapt the treatment and effectively relieve foot pain.
Conclusion
We have presented the symptoms, causes, and treatment options for Ledderhose disease. If painless nodules appear, it is best to consult to reduce the risk of them becoming symptomatic.