Ledderhose Disease: Clinical, Radiological (Ultrasound and MRI), and Anatomopathological Findings

Abstract

Plantar fibromatosis, or Ledderhose disease, is a rare hyperproliferative disorder of the plantar aponeurosis. It may occur at any age, with the greatest prevalence at middle age and beyond. This disorder is more common in men than woman and it is sometimes associated with other forms of fibromatosis. Diagnosis is based on clinical examination. Ultrasound (US) and magnetic resonance imaging (MRI) can be useful to confirm the diagnosis. A 44-year-old man with Ledderhose disease who underwent ultrasound and MR is described in this paper.

Eponyms in dermatology literature linked to fifi bromatoses

“…Ledderhose's disease [1,6,7] Also known as Plantar fi bromatosis or Morbus Ledderhose. It is a fi brous proliferation arising within the plantar fascia end exhibits typical clinical nodular features.…”

Endoscopic Subtotal Fasciectomy of the Foot

“…1,2 Clinical and pathologic studies have classified plantar fibromatosis into 3 stages: (1) proliferative with increased activity of fibroblasts; (2) involutional with typical nodule formation; and (3) residual with a reduction of fibroblast activity, collagen maturation, and late tissue contractures. 1,3 Patients with plantar fibromatosis may or may not present with clinical symptoms. 1,2 Symptoms commonly include the feeling of a mass in the foot, difficulty in fitting shoes, and pain and tenderness while weightbearing.…”

“…7 Nonsurgical treatment is the first line of treatment to reduce the progression of symptoms and includes intralesional cortisone or collagenase injections, stretching exercise, custom-molded orthotics, antiinflammatory drugs, physical therapy, shockwave therapy, and radiotherapy. [1][2][3]7,8 These modalities frequently do not halt the tumor progression, but they may decrease the patient's symptoms to a tolerable level. 2 Because of the high recurrence rate associated with surgical treatment, operation is indicated only when the lesions are highly symptomatic and conservative measures fail or the diagnosis is in question.…”

“…6,9 The surgical options include local excision, wide excision, and subtotal and complete plantar fasciectomy. 3,6,8 There is a high incidence of recurrence after both local and wide excision because of the diffuse nature of the lesion along the plantar aponeurosis. 9 Subtotal plantar fasciectomy, however, has been reported to decrease the risk of recurrence in both primary and recurrent tumor cases.…”

“…9 Subtotal plantar fasciectomy, however, has been reported to decrease the risk of recurrence in both primary and recurrent tumor cases. 2,3 Although adjuvant radiotherapy may result in improved local control, there are risks of radiation-induced impaired function of the foot, impaired wound healing, lymph edema, marked fibrosis, fracture of irradiated bone, and radiation-induced malignancy. In view of its potentially serious side effects, postoperative radiotherapy should be used highly selectively for this benign disease.…”