24 Mar A strange lump under your arch? Ledderhose disease and treatment recommendations?
After seeing two patients present with Ledderhose Disease this week and also being asked over the years about these strange “lumps” that appear in the arch I thought it was a good time to write a little bit about this apparent rare disease.
What is it?
Also commonly referred to as Plantar fibromatosis it is a benign (non-spreading) growth of abnormal fibrosis tissue in the plantar aponeurosis also known as the plantar fascia 1. The plantar fascia extends from the heels to the toes and plays an integral role in foot function and our body’s movement. The abnormal fibrosis tissue usually appears and feels like a hard, round lump under the medial arch of the feet. They are usually painless but if they grow large enough they can potentially affect the normal functioning of the plantar fascia as well as simply get in the way by pressing against the ground and against shoes especially if the person has a flatter arch profile.
They can occur at any age but most commonly in the middle aged to older population with men also more likely to be affected1; 2. Although the exact cause of the disease is not known it can be associated with pre-existing conditions that cause excessive connective tissue formation such as Dupuytren’s disease (which is a painless thickening and tightening of tissue beneath the skin on the palm of the hands and fingers)1. Trauma, long term alcohol consumption, chronic liver disease, diabetes and epilepsy have also been reported to be associated with the disease 1.
How is it treated?
Early treatment includes stretching and accommodative soft orthotics often with cut outs where the fibromas sit. Physical therapy to address plantar fascia and lower leg tightness can also be a useful adjunct although it is not recommended to massage over the fibromas. If the disease progresses then Intralesional cortisone injection, non-steroidal anti-rheumatic drugs, irradiation of the plantar surface, shockwave therapy and partial or complete fasciectomy (surgery) as ultimate therapy may be indicated 3; 4
If you think you may have ledderhose disease make sure you get into see your Podiatrist who will be able to commence conservative treatment. They will also be able to refer you back to your GP who can make a referral to the correct specialist if further treatment is needed if pain does not improve.
1 FAUSTO DE SOUZA, D. et al. Ledderhose disease: an unusual presentation. J Clin Aesthet Dermatol, v. 3, n. 9, p. 45-7, Sep 2010. ISSN 1941-2789. Disponível em: < https://www.ncbi.nlm.nih.gov/pubmed/20877526 >.
2 OMOR, Y. et al. Ledderhose Disease: Clinical, Radiological (Ultrasound and MRI), and Anatomopathological Findings. Case Rep Orthop, v. 2015, p. 741461, 2015. ISSN 2090-6749. Disponível em: < https://www.ncbi.nlm.nih.gov/pubmed/26425380 >.
3 BECKMANN, J. et al. [Plantar fibromatosis: therapy by total plantarfasciectomy]. Zentralbl Chir, v. 129, n. 1, p. 53-7, Jan 2004. ISSN 0044-409X. Disponível em: < https://www.ncbi.nlm.nih.gov/pubmed/15011113 >.
4 VEITH, N. T. et al. Plantar fibromatosis–topical review. Foot Ankle Int, v. 34, n. 12, p. 1742-6, Dec 2013. ISSN 1944-7876. Disponível em: < https://www.ncbi.nlm.nih.gov/pubmed/24043350 >.