Unlock the Secrets to Beating Ledderhose Disease: Top Treatments, Diet Tips & Lifestyle Hacks!

Ledderhose Disease (LD), also known as plantar fibromatosis, is a rare condition characterized by the development of benign nodules or lumps on the plantar fascia, the thick band of tissue on the bottom of the foot that supports the arch. It is essential not to confuse it with plantar fasciitis. This article provides a thorough overview of Ledderhose Disease, including its symptoms, causes, treatment options, and the potential role of diet and lifestyle adjustments in managing the condition.

What is Ledderhose Disease?

Ledderhose disease, or plantar fibromatosis, is a disorder affecting the plantar fascia, a thick fibrous membrane located between the heel bone and the toes. This condition is characterized by the appearance of nodules, known as fibromas, on the plantar fascia. These nodules develop gradually, leading to several characteristic symptoms.

Symptoms of Ledderhose Disease

Palpable nodules under the skin of the soles of the feet, which are sensitive to touch.
Discomfort when bearing weight, creating the sensation of walking on foreign objects.
Pain during walking or running.
Difficulty wearing shoes.
Tightening of the skin on the foot.
Itching or stinging sensation in the surrounding area.
Pain in the ankle joints, potentially exacerbated by favoring the nodules.
In rare cases, nodules may appear on the toes, and pressure from the nodules in the foot can cause the toes to contract.

Causes and Risk Factors

The precise causes of plantar fibromatosis remain not fully understood. However, there is evidence suggesting a genetic predisposition to this condition. Despite its hereditary nature, several risk factors have been identified, including:

Age: Plantar fibromatosis is more prevalent in individuals over 40.
Gender: Men are more likely to be affected than women.
Medical history: Certain medications (such as isoniazid and barbiturates), diabetes, foot trauma, and arch surgery can increase the risk of developing nodules on the plantar fascia.
Co-existing conditions: Dupuytren's disease (affecting the hands) and Peyronie's disease (affecting the penis) increase the risk of developing Ledderhose disease.
Alcoholism: Long-term regular alcohol consumption may be a risk factor.
Liver disease, diabetes and epilepsy: Plantar fibromatosis may be worse when associated with these diseases.
Repeated trauma to the feet: Some doctors say it's an aggressive healing response to small tears in the plantar fascia.

Treatment Options for Ledderhose Disease

Since LD is a rare disease, there is not a lot of research or available information for standard treatment options. Suggestion for treatment is to go from more conservative to least conservative to avoid additional fibromas from forming or causing other issues. Different people respond differently to the treatments and there is not a one-size-fits all solution. If you look at the published studies on LD, their patient size for the studies are very small so definitive conclusions cannot be drawn from such small studies but can provide you with more information. In addition, as more information is gathered regarding this disease, older methods of suggested treatment may not be current and applicable.

Conservative Treatments

Observation: If the fibroma is not causing pain or issues, leaving it alone is often the best option.
Shoe Modifications and Inserts: When fibromas make it difficult to wear shoes, using shoe inserts with cut-outs to accommodate the fibromas can ease walking. Soft shoes that minimize direct pressure on the fibromas are often sought. However, they lack support, potentially causing pain elsewhere, especially with increased activity. Stability shoes may be a better long-term solution once the fibromas are managed.
Orthotics: Custom molded orthotics can disperse pressure at the mass with weight bearing and relieve tension off of the plantar fascia.
Stretching: Stretching, similar to that done for plantar fasciitis, can be useful and involves stretching.
Physical Therapy: Physical therapy helps break tissue accumulation in the foot. A physical therapist will help you develop a routine of strength training and stretching exercises that can increase blood circulation and stimulate cell growth. Increased circulation can also reduce inflammation and relieve pain caused by a plantar fibroma. But there are no published studies that show that physical therapy has a significant beneficial result in the treatment of plantar fibromas.

Topical and Injectable Treatments

Topical Gels: 15% Verapamil gel and 1% Diclofenac gel can be applied to the bottoms of the feet. Verapamil is not the oral dosage form but a gel formulated for topical use. It is suggested to vigorously rub a pea-sized amount of Verapamil gel from the big toe to the heel for 2-3 minutes to improve absorption, followed by 1% Diclofenac gel for inflammation after 5-10 minutes.
Corticosteroid Injections: Cortisone shots may or may not be helpful, and experiences have varied. There is a thought that they may cause more trauma to the foot causing additional fibromas to form. Injecting a corticosteroid into the nodule can reduce pain and inflammation. If the inflammation goes down, it may become easier to walk, stand, and wear shoes. Although corticosteroid injections are effective for relieving any inflammatory process, the nodule may continue to grow.
Enzyme Injections: Hyaluronidase with Triamcinolone acetonide injected into the middle of the fibroma with ultrasound guidance. The enzyme injections tend to work better on larger fibromas. A medial block can be used to block the pain during injections.

Other Treatments

Radiation Treatments: Radiation treatments are about 80% effective but can cause harm to good tissue as well as bad. It takes about 6-12 months to get the fibromas to decrease with radiation. Radiation does help to suppress new regrowth but is not specific and may have fibrous in subcutaneous tissue impacted as a bad side effect.
Surgery: Surgery is generally not advised because the trauma from the surgery can cause additional fibromas to form. Complete fasciectomy may render the foot to be unstable making it a challenge to walk. After partial resection, there is a high recurrence rate with increased risk of complications and more aggressive ingrowth into anatomical structures.

The Role of Diet and Supplements

What you eat may seem unrelated to the condition of your hand, but diet changes can actually help reduce the symptoms associated with Dupuytren’s contracture. Once it becomes a habit, eating healthy may feel easy. But, if you aren’t sure where to start, it can take a little time to learn what works for your new meal plan. A healthy diet does not necessarily mean a boring or bland diet. It can vary widely from person to person.

Dietary Considerations

Portion sizes: Whether you are having a main dish or a dessert, try to keep the amount you eat reasonable and listen to your body to eat to fullness.
Whole and fresh foods: When it comes to selecting foods, try to opt for whole and fresh options. Try cooking with fresh vegetables instead of canned. Opt for fresh fruit instead of canned fruit cocktail. Look for whole grains. These changes can help cut out unhealthy ingredients, such as sugars and preservatives.
Reduce fat consumption: You can also opt for less fatty options of your favorite foods. Still enjoy dairy products, but go with the low-fat version. Still include meat in your diet, but look for healthier options. Try turkey burgers instead of beef burgers. Find new ways to cook lean meat, like chicken breast or fish.
Anti-inflammatory foods: Foods eaten as a part of an anti-inflammatory diet may be a helpful consideration as well. Certain foods can potentially contribute to your symptoms. Certain foods with anti-inflammatory properties are particularly beneficial in hot weather. These include ginger, curcumin, cider vinegar, fish oil, olive oil, garlic, fruit and sweet potatoes.

Supplements

Certain supplements can help reduce inflammation, which may play a role in managing the symptoms of Dupuytren’s disease.

NAC (N-acetylcysteine): one 600 mg daily. 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.
PABA (para-aminobenzoic acid): 500 mg twice a day. PABA is also known as 4-aminobenzoic acid is sometimes considered part of the B family of vitamins.
Neprinol: which is a combination of oral enzymes - 2 capsules two to three times a day on an empty stomach.
Vitamin E: Vitamin E is an antioxidant. You likely ingest a certain amount in your regular diet, but you can also take it as a supplement. Vitamin E may play a potential role in protecting the body’s cells from damage.
Zinc: Zinc is an important mineral for your overall health. It plays a role in a healthy immune system and wound healing.
Magnesium: Magnesium, another important mineral, is an important part of any diet. Sometimes you do not get enough of it through the foods you eat, which is why you can opt to take a magnesium supplement. Low levels of magnesium have been connected to a higher risk of developing diabetes.
Turmeric: Turmeric is a spice often used in cooking.

Lifestyle Adjustments for Managing Ledderhose Disease

Avoid Tobacco and alcohol: Tobacco use is one of the top answers to this question. Research has shown that smoking cigarettes has a statistically significant link with Dupuytren’s contracture. Smoking cessation can be an important step early on in the progression of the disease. Alcohol use disorder and smoking cigarettes commonly go hand in hand. Drinking alcoholic beverages only in moderation may reduce the risk of forming nodules.
Practice a looser grip: When we grip something like a tool or a cup of water, the palm usually curls around the object. Try to remember to protect your hands whenever you need to grip something by using lighter pressure.
Wear gloves: Some objects, like various tools, require a tight grip in order to be used effectively.
Massage: You can conduct a gentle massage of the whole hand, including the palm and fingers, with your unaffected hand. Remember to be gentle as you massage the hand. Rub the area including and around the thickening tissue of the palm, and work your way up to the fingers. You may be able to find a professional massage therapist with experience working with Dupuytren’s disease if you would like some outside help.
Gentle stretching of the foot: Gentle stretching of the foot may help ease tight connective tissues in the feet.
Regular massage: Regular massage is another way to bring mobility to the area and may also help relieve pain. During a massage, it is important to avoid the nodules themselves, as they can be very painful when touched. Focusing on gently stretching the tissues around them is the best way to ease symptoms.

Footwear and Ledderhose Disease

Management of Ledderhose disease requires appropriate footwear. To reduce pain and increase walking comfort, shoes must:

Be adapted to the morphology of the feet, to guarantee good support without compressing them. Comfort shoes are generally available in a range of sizes and widths to suit all types of foot.
Provide good structure, with reinforced arch and heel support.
Offer a thick, flexible insole to minimize shock-related pain. Make sure the insole is removable. So you can easily replace it with your own orthotics if necessary.
Be fitted with a low heel, as high heels increase the risk of plantar fasciitis.

Living with Ledderhose Disease

Living with Ledderhose Disease can be challenging, but with the right approach, symptoms can be managed effectively.

Early Intervention: Carefully watch your symptoms over time. If you notice a significant change or the bend of your fingers begins to interfere with your daily life, it is time to seek professional treatment. Do not wait until your finger is bent all the way to your palm. Rather, seek help when your fingers reach a 20-degree or 40-degree bend.
Regular monitoring: The progression of the disease is slow. Some people may never experience the contracture of their fingers. In other cases, the disease may progress toward contraction.
Seeking Professional Help: The medical community has yet to find a cure for Dupuytren’s disease, so there is a possibility it will return following treatment. At OrthoBethesda, we understand the frustrating impact Dupuytren’s disease may have on your life.

Read also: Explore Diet and Disease

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