Ledderhose

Ledderhose disease, also known as plantar fibromatosis, is a rare, benign fibroproliferative condition of the plantar fascia, the thick band of tissue on the bottom of the foot. It is the plantar counterpart of Dupuytren's contracture of the hand and typically presents with one or more firm nodules on the sole, which may develop into cords as they enlarge.

The condition most often affects middle-aged men, though cases occur in other groups. Potential risk factors or associations that have been reported include diabetes mellitus, a family history of fibromatoses, smoking, and liver disease, but the exact cause remains unknown. The disease is generally slow growing and progressive.

Patients usually notice painless or mildly painful nodules that may irritate the sole during standing or walking, especially if they bear weight on the nodules. In advanced cases, plantar cords can limit foot movement and contribute to altered gait or toe deformities.

Diagnosis is based on clinical examination; imaging such as ultrasound or magnetic resonance imaging can help determine the size and extent of the lesions and distinguish them from other conditions. Biopsy is rarely needed but may be employed if malignancy is a concern.

Treatment ranges from observation for asymptomatic lesions to active intervention for symptomatic disease. Conservative measures include footwear modification, orthotics, padding, and physical therapy. Intralesional corticosteroid injections may be used, though evidence is variable. Radiation therapy has been used in some refractory cases. Surgical options, such as wide excision or partial fasciectomy, are considered for disabling disease, but recurrence after surgery is common, and outcomes vary.