Ledderhose Disease

What is Ledderhose disease?

Ledderhose disease (plantar fibromatosis) is a rare disease. It affects the plantar fascia, which is the thick layer of tissue (ligament) that protects and supports the bottom of your foot. If you have Ledderhose disease, small, hard nodules develop slowly on the bottom of your feet. These nodules are noncancerous (benign) thickening of this ligament. They look like bumps, knots or growths on the surface of your skin. The bumps may grow to be 1 to 2 centimeters in size.

What are the stages of Ledderhose disease?

There are three stages to Ledderhose disease:

• Stage I: There's an increase in the number of cells in the area.
• Stage II: A growth or knot forms on your skin.
• Stage III: The tissue squeezes together (contracts). Your toes may contract too.

Who does Ledderhose disease affect?

Ledderhose disease affects people of any age. However, it’s more common in men who are middle-aged or older.

Ledderhose disease often affects those who have:

• Dupuytren’s disease.
• Peyronie’s disease.
• Thickening over the tops of your finger joints (knuckle pads).
• Frozen shoulder.
• Epilepsy.
• Alcohol use disorder.

How common is Ledderhose disease?

Ledderhose disease affects less than 200,000 people in the United States every year. However, it becomes more common in middle-aged or older people, with up to 25% developing the disease.

In 25% of cases, Ledderhose disease affects both feet.

How does Ledderhose disease affect my body?

Ledderhose disease may cause discomfort. Your feet may become swollen, and the growths on your feet may be painful. These issues can affect your ability to walk.

In rare cases, your toes may curl down toward the bottom of your feet. It may be difficult or even impossible to straighten your toes. It tightens the ligament on the bottom of your foot (plantar fascia) and can predispose you to developing plantar fasciitis.

What are the symptoms of Ledderhose disease?

Symptoms of Ledderhose disease may include:

• Pain and swelling in your foot.
• Difficulty walking.
• A small collection of bumps on the bottom of your foot.
• Toes may curl.

What causes Ledderhose disease?

Healthcare providers don’t know what causes Ledderhose disease. However, it seems to occur in those who have other types of fibromatosis. Tell your healthcare provider if you have Dupuytren’s disease, Peyronie’s disease or knuckle pads.

Does Ledderhose disease cause other problems in the body?

Ledderhose disease can cause pain in the bottom of your feet, including your toes. The pain can affect the way you walk. As a result, you may change the way you naturally walk to offset your pain. This can put too much pressure on other parts of your feet and ankles, which may cause additional injuries.

Ledderhose disease is often associated with diabetes and epilepsy, but it doesn’t cause them.

How is Ledderhose disease diagnosed?

Before examining your foot, your healthcare provider may ask several questions, including:

• Do you have a biological family history of Ledderhose disease?
• Have you ever been diagnosed with Dupuytren’s disease, Peyronie’s disease, knuckle pads or any other type of fibromatosis?
• Do you have diabetes?
• Do you have epilepsy?

Your healthcare provider will examine your foot. They will:

• Check for swelling, bruising, lumps, sores or deformities.
• Note any tender or painful areas along the bottom of your feet and your heels.
• Look over your Achilles tendon and the muscles around the tendon.
• Check your foot’s range of motion.
• Ask you to walk a short distance and note how your feet and ankles move.

What tests will be done to diagnose Ledderhose disease?

Your healthcare provider may conduct the following tests to diagnose Ledderhose disease:

• Ultrasound: After examining your signs, symptoms and medical history, your healthcare provider may conduct an ultrasound to confirm their clinical diagnosis.
• Magnetic resonance imaging (MRI): With advanced stages of Ledderhose disease, nodules may extend deeper into the bottom of your foot. An MRI shows how aggressive your case may be.
• Biopsy: Your healthcare provider may remove some tissue, cells or fluid from your foot (biopsy). A biopsy will confirm that a growth isn’t a cancerous tumor.

What type of doctor treats Ledderhose disease?

Your regular healthcare provider can diagnose and treat the earliest stages of Ledderhose disease. If your pain doesn’t go away after several months of nonsurgical treatment, your healthcare provider may refer you to a foot and ankle surgeon.

How is Ledderhose disease treated?

In the earliest stages of Ledderhose disease, conservative treatments can provide relief. These treatments include:

• Orthotics: Over-the-counter shoe inserts or custom orthotics provide relief. You can cut holes into your shoe inserts around the growths on your foot to prevent direct pressure. Offloading felt pads can also be applied to your inserts to accomplish this same goal.
• Massage: Gently massage the bottom of your foot. Avoid touching the growths because that may increase your pain.
• Stretching: Stretch the connective tissues in the bottom of your feet.
• Ice: Apply an ice pack covered in a light towel to the bottom of your foot for up to 20 minutes, three to four times per day.
• Medications: Over-the-counter non-steroidal anti-inflammatory medications (NSAIDs), such as aspirin, ibuprofen and naproxen, will reduce the pain and inflammation associated with your Ledderhose disease. Not everyone can take NSAIDs, so it’s a good idea to check with your healthcare provider before use.

What medications/treatments are used to treat Ledderhose disease?

If your pain doesn’t decrease or stop after several months of conservative treatment, your healthcare provider may suggest the following:

• Intralesional steroids: Your healthcare provider may inject steroids directly into your growths. Steroids will decrease inflammation and shrink your growths.
• Verapamil: Verapamil is a calcium channel blocker. It stops calcium from moving through parts of your body. Verapamil has anti-inflammatory properties and may decrease the size of your growths. You can apply verapamil gel to your growths twice a day for up to nine months.
• Radiation therapy: In the early stages of Ledderhose disease, radiation therapy stops your growths from getting larger. It can also help growths decrease in size.
• Extracorporeal shock wave therapy (ESWT): Sound waves can decrease pain and soften the growths and tissue in your feet.
• Tamoxifen: Estrogen makes certain cells contract. Tamoxifen is an estrogen-blocking drug. It may stop growths from getting larger or even make them shrink.
• Collagenase injection: Collagenase is a medicine that breaks up hard tissue. Your healthcare provider may inject collagenase directly into your growths.
• Surgery: Surgery is rarely needed. However, if your pain hasn’t improved in 6 to 12 months, you may have to see a foot and ankle surgeon. They may remove part of the plantar fascia (fasciectomy), but recurrence (return) is common.

How soon after treatment will I feel better?

In many cases, you should feel better after several weeks of proper treatment.

How can I reduce my risk of Ledderhose disease?

Because healthcare providers don’t know what causes Ledderhose disease, it may not be possible to prevent it. However, you may lower your risk of developing Ledderhose disease by:

• Drinking alcohol in moderation.
• Routinely stretching your feet.
• Walking regularly.
• Wearing supportive shoes and orthotics.

What can I expect if I have Ledderhose disease?

With proper diagnosis and treatment, the outlook for people with Ledderhose disease is good. Follow your healthcare provider’s instructions for at-home treatments. Be sure to schedule follow-up appointments to monitor your progress.

When should I see my healthcare provider?

Schedule an appointment with your healthcare provider if you:

• Experience long-lasting pain in the bottom of your feet.
• Have difficulty walking.
• Notice the development of growths or bumps near the middle of the bottom of your feet.
• Have difficulty straightening your toes.

What questions should I ask my healthcare provider?

• Why did this happen to me?
• Do I have any other types of fibromatosis?
• Do I need a biopsy?
• What activities should I avoid? For how long?
• What can I do to manage my pain?
• What treatments do you recommend?
• Do you think I should have surgery?

A note from Cleveland Clinic

Though Ledderhose disease is rare, it can be very painful and frustrating. You may notice changes in the way you walk. If you experience long-lasting pain in your feet, notice growths on the bottom of your feet or have difficulty straightening your toes, talk to your healthcare provider. You can treat Ledderhose disease in its earliest stages with shoe inserts, massages, stretching, ice and over-the-counter medications. In later stages, your healthcare provider may refer you to a foot and ankle specialist.