Plantar fibromatosis

Last updated
Plantar fibromatosis
Other namesLedderhose's disease
Autosomal dominant - en.svg
This condition is inherited in an autosomal dominant manner [1]
Specialty Rheumatology   OOjs UI icon edit-ltr-progressive.svg

Plantar fascial fibromatosis, also known as Ledderhose's disease, Morbus Ledderhose, and plantar fibromatosis, is a relatively uncommon [2] non-malignant thickening of the feet's deep connective tissue, or fascia. In the beginning, where nodules start growing in the fascia of the foot, the disease is minor.[ citation needed ] Over time, walking becomes painful. The disease is named after Georg Ledderhose, a German surgeon who described the condition for the first time in 1894. [3] [4] A similar disease is Dupuytren's disease, which affects the hand and causes bent hand or fingers.

Contents

As in most forms of fibromatosis, it is usually benign and its onset varies with each patient. [5] The nodules are typically slow growing [2] [5] and most often found in the central and medial portions of the plantar fascia. [2] Occasionally, the nodules may lie dormant for months to years only to begin rapid and unexpected growth. [5] Options for intervention include radiation therapy, cryosurgery, treatment with collagenase clostridium histolyticum, or surgical removal only if discomfort hinders walking. [6]

Signs and symptoms

Plantar fibromatosis is most frequently present on the medial border of the sole, near the highest point of the arch. [6] The lump is usually painless [6] and the only pain experienced is when the nodule rubs on the shoe or floor. [5] The overlying skin is freely movable, and contracture of the toes does not occur in the initial stages. [6]

A plantar fibroma right below the 2nd toe. Plantar fibroma on foot.jpg
A plantar fibroma right below the 2nd toe.

The typical appearance of plantar fibromatosis on magnetic resonance imaging (MRI) is a poorly defined, infiltrative mass in the aponeurosis next to the plantar muscles. [7]

Only 25% of patients show symptoms on both feet (bilateral involvement). The disease may also infiltrate the dermis or, very rarely, the flexor tendon sheath. [8]

Risk factors

The histological and ultrastructural features of Ledderhose and Dupuytren's disease are the same, which supports the hypothesis that they have a common cause and pathogenesis. [8] As with Dupuytren's disease, the root cause(s) of Ledderhose's disease are not yet understood. It has been noted that it is an inherited disease and of variable occurrence within families, i.e. the genes necessary for it may remain dormant for a generation or more and then surface in an individual, or be present in multiple individuals in the same generation with varying degree. [9]

There are certain identified risk factors. The disease is more commonly associated with -

There is also a suspected, although unproven, link between incidence and alcoholism, smoking, liver diseases, thyroid problems, and stressful work involving the feet.[ citation needed ]

Diagnosis

A combination of physical examination of the arch and plantar fascia, as well as ultrasound imaging by a physician is the usual path to diagnosis.[ citation needed ]

An MRI (Magnetic Resonance Imaging) scan is usually the imaging of choice to determine between other possible conditions such as ganglion cysts. MRI tends to be more accurate than x-ray or ultrasound, showing the full extent of the condition. [10]

Treatment

Although the origin of the disease is unknown, there is speculation that it is an aggressive healing response to small tears in the plantar fascia, almost as if the fascia over-repairs itself following an injury. There is also some evidence that it might be genetic. [5]

In the early stages, when the nodule is single and/or smaller, it is recommended to avoid direct pressure to the nodule(s). Soft inner soles on footwear and padding may be helpful. [5]

MRI and sonogram (diagnostic ultrasound) are effective in showing the extent of the lesion, but cannot reveal the tissue composition. Even then, recognition of the imaging characteristics of plantar fibromatoses can help in the clinical diagnosis. [2]

Surgery of Ledderhose's disease is difficult because tendons, nerves, and muscles are located very closely to each other. Additionally, feet have to carry heavy load, and surgery might have unpleasant side effects. If surgery is performed, the biopsy is predominantly cellular and frequently misdiagnosed as fibrosarcoma. [6] Since the diseased area (lesion) is not encapsulated, clinical margins are difficult to define. As such, portions of the diseased tissue may be left in the foot after surgery. Inadequate excision is the leading cause of recurrence. [2] [7]

Radiotherapy has been shown to reduce the size of the nodules and reduce the pain associated with them. It is approximately 80% effective, with minimal side effects. [11]

Post-surgical radiation treatment may decrease recurrence. [7] There has also been variable success in preventing recurrence by administering gadolinium. [7] Skin grafts have been shown to control recurrence of the disease. [9]

In few cases shock waves also have been reported to at least reduce pain and enable walking again.[ citation needed ] Currently in the process of FDA approval is the injection of collagenase.[ citation needed ] Recently successful treatment of Ledderhose with cryosurgery (also called cryotherapy) has been reported.[ citation needed ]

Cortisone injections, such as triamcinolone, [4] and clobetasol ointments [9] have been shown to stall the progression of the disease temporarily, although the results are subjective and large-scale studies far from complete. Injections of superoxide dismutase have proven to be unsuccessful in curing the disease [9] while radiotherapy has been used successfully on Ledderhose nodules. [12]

Topical verapamil is also used to treat plantar fibromatosis. [13] [14]

See also

Related Research Articles

<span class="mw-page-title-main">Peyronie's disease</span> Medical condition

Peyronie's disease is a connective tissue disorder involving the growth of fibrous plaques in the soft tissue of the penis. Specifically, scar tissue forms in the tunica albuginea, the thick sheath of tissue surrounding the corpora cavernosa, causing pain, abnormal curvature, erectile dysfunction, indentation, loss of girth and shortening.

<span class="mw-page-title-main">Dupuytren's contracture</span> Disease with gradual bending of the fingers due to scar tissue build-up within the palms

Dupuytren's contracture is a condition in which one or more fingers become permanently bent in a flexed position. It is named after Guillaume Dupuytren, who first described the underlying mechanism of action, followed by the first successful operation in 1831 and publication of the results in The Lancet in 1834. It usually begins as small, hard nodules just under the skin of the palm, then worsens over time until the fingers can no longer be fully straightened. While typically not painful, some aching or itching may be present. The ring finger followed by the little and middle fingers are most commonly affected. It can affect one or both hands. The condition can interfere with activities such as preparing food, writing, putting the hand in a tight pocket, putting on gloves, or shaking hands.

<span class="mw-page-title-main">Plantar fasciitis</span> Connective tissue disorder of the heel

Plantar fasciitis or plantar heel pain is a disorder of the plantar fascia, which is the connective tissue which supports the arch of the foot. It results in pain in the heel and bottom of the foot that is usually most severe with the first steps of the day or following a period of rest. Pain is also frequently brought on by bending the foot and toes up towards the shin. The pain typically comes on gradually, and it affects both feet in about one-third of cases.

<span class="mw-page-title-main">Cryosurgery</span> Cauterization by freezing tissue

Cryosurgery is the use of extreme cold in surgery to destroy abnormal or diseased tissue; thus, it is the surgical application of cryoablation. The term comes from the Greek words cryo (κρύο) and surgery meaning "hand work" or "handiwork". Cryosurgery has been historically used to treat a number of diseases and disorders, especially a variety of benign and malignant skin conditions.

<span class="mw-page-title-main">Adhesive capsulitis of the shoulder</span> Painful disease restricting movement

Adhesive capsulitis, also known as frozen shoulder, is a condition associated with shoulder pain and stiffness. It is a common shoulder ailment that is marked by pain and a loss of range of motion, particularly in external rotation. There is a loss of the ability to move the shoulder, both voluntarily and by others, in multiple directions. The shoulder itself, however, does not generally hurt significantly when touched. Muscle loss around the shoulder may also occur. Onset is gradual over weeks to months. Complications can include fracture of the humerus or biceps tendon rupture.

<span class="mw-page-title-main">Fibromatosis</span> Medical condition

The term fibromatosis refers to a group of soft tissue tumors which have certain characteristics in common, including absence of cytologic and clinical malignant features, a histology consistent with proliferation of well-differentiated fibroblasts, an infiltrative growth pattern, and aggressive clinical behavior with frequent local recurrence. It is classed by the World Health Organization as an intermediate soft tissue tumor related to the sarcoma family. Arthur Purdy Stout coined the term fibromatosis, in 1954.

In human anatomy, the dorsalis pedis artery is a blood vessel of the lower limb. It arises from the anterior tibial artery, and ends at the first intermetatarsal space. It carries oxygenated blood to the dorsal side of the foot. It is useful for taking a pulse. It is also at risk during anaesthesia of the deep peroneal nerve.

<span class="mw-page-title-main">Nerve block</span> Deliberate inhibition of nerve impulses

Nerve block or regional nerve blockade is any deliberate interruption of signals traveling along a nerve, often for the purpose of pain relief. Local anesthetic nerve block is a short-term block, usually lasting hours or days, involving the injection of an anesthetic, a corticosteroid, and other agents onto or near a nerve. Neurolytic block, the deliberate temporary degeneration of nerve fibers through the application of chemicals, heat, or freezing, produces a block that may persist for weeks, months, or indefinitely. Neurectomy, the cutting through or removal of a nerve or a section of a nerve, usually produces a permanent block. Because neurectomy of a sensory nerve is often followed, months later, by the emergence of new, more intense pain, sensory nerve neurectomy is rarely performed.

<span class="mw-page-title-main">Morton's neuroma</span> Benign neuroma of an intermetatarsal plantar nerve

Morton's neuroma is a benign neuroma of an intermetatarsal plantar nerve, most commonly of the second and third intermetatarsal spaces, which results in the entrapment of the affected nerve. The main symptoms are pain and/or numbness, sometimes relieved by ceasing to wear footwear with tight toe boxes and high heels. The condition is named after Thomas George Morton, though it was first correctly described by a chiropodist named Durlacher.

Adenomyoma is a tumor (-oma) including components derived from glands (adeno-) and muscle (-my-). It is a type of complex and mixed tumor, and several variants have been described in the medical literature. Uterine adenomyoma, the localized form of uterine adenomyosis, is a tumor composed of endometrial gland tissue and smooth muscle in the myometrium. Adenomyomas containing endometrial glands are also found outside of the uterus, most commonly on the uterine adnexa but can also develop at distant sites outside of the pelvis. Gallbladder adenomyoma, the localized form of adenomyomatosis, is a polypoid tumor in the gallbladder composed of hyperplastic mucosal epithelium and muscularis propria.

<span class="mw-page-title-main">Aggressive fibromatosis</span> Medical condition

Aggressive fibromatosis or desmoid tumor is a rare condition. Desmoid tumors are a type of fibromatosis and related to sarcoma, though without the ability to spread throughout the body (metastasize). The tumors arise from cells called fibroblasts, which are found throughout the body and provide structural support, protection to the vital organs, and play a critical role in wound healing. These tumors tend to occur in women in their thirties, but can occur in anyone at any age. They can be either relatively slow-growing or malignant. However, aggressive fibromatosis is locally aggressive and can cause life-threatening problems or even death when the tumors compress vital organs such as intestines, kidneys, lungs, blood vessels, or nerves. The condition is rarely fatal. Most cases are sporadic, but some are associated with familial adenomatous polyposis (FAP). Approximately 10% of individuals with Gardner's syndrome, a type of FAP with extracolonic features, have desmoid tumors.

<span class="mw-page-title-main">Cryoablation</span> Process using extreme cold to destroy tissue

Cryoablation is a process that uses extreme cold to destroy tissue. Cryoablation is performed using hollow needles (cryoprobes) through which cooled, thermally conductive, fluids are circulated. Cryoprobes are positioned adjacent to the target in such a way that the freezing process will destroy the diseased tissue. Once the probes are in place, the attached cryogenic freezing unit removes heat from ("cools") the tip of the probe and by extension from the surrounding tissues.

<span class="mw-page-title-main">Thyroid nodule</span> Medical condition

Thyroid nodules are nodules which commonly arise within an otherwise normal thyroid gland. They may be hyperplastic or tumorous, but only a small percentage of thyroid tumors are malignant. Small, asymptomatic nodules are common, and often go unnoticed. Nodules that grow larger or produce symptoms may eventually need medical care. A goitre may have one nodule – uninodular, multiple nodules – multinodular, or be diffuse.

Diffuse infantile fibromatosis is a rare condition affecting infants during the first three years of life. This condition is a multicentric infiltration of muscle fibers with fibroblasts resembling those seen in aponeurotic fibromas, presenting as lesions and tumors confined usually to the muscles of the arms, neck, and shoulder area Diffuse infantile fibromatosis is characterized by fast growing benign tumors. This disorder is known to be caused by mutations in germline variants, PDGFRB and NOTCH3, which may be generationally-inherited through autosomal dominant and recessive traits. Although diffuse infantile fibromatosis is classified as benign, it can still lead to life-threatening complications and damage other organs.

The hand is a very complex organ with multiple joints, different types of ligament, tendons and nerves. Hand disease injuries are common in society and can result from excessive use, degenerative disorders or trauma.

Collagenase clostridium histolyticum is an enzyme produced by the bacterium Clostridium histolyticum that dismantles collagen. It is used as a powder-and-solvent injection kit for the treatment of Dupuytren's contracture, a condition where the fingers bend towards the palm and cannot be fully straightened, and Peyronie's disease, a connective tissue disorder involving the growth of fibrous plaques in the soft tissue of the penis. BioSpecifics Technologies developed the preparation, which is manufactured and marketed by Endo Pharmaceuticals as Xiaflex in the US and by Sobi as Xiapex in Europe.

Hathewaya histolytica is a species of bacteria found in feces and the soil. It is a motile, gram-positive, aerotolerant anaerobe. H. histolytica is pathogenic in many species, including guinea pigs, mice, and rabbits, and humans. H. histolytica has been shown to cause gas gangrene, often in association with other bacteria species.

Ultrasonography of liver tumors involves two stages: detection and characterization.

<span class="mw-page-title-main">Plantar fascial rupture</span> Medical condition

A plantar fascial rupture, is a painful tear in the plantar fascia. The plantar fascia is a connective tissue that spans across the bottom of the foot. The condition plantar fasciitis may increase the likelihood of rupture. A plantar fascial rupture may be mistaken for plantar fasciitis or even a calcaneal fracture. To allow for proper diagnosis, an MRI is often needed.

In CT scan of the thyroid, focal and diffuse thyroid abnormalities are commonly encountered. These findings can often lead to a diagnostic dilemma, as the CT reflects nonspecific appearances. Ultrasound (US) examination has a superior spatial resolution and is considered the modality of choice for thyroid evaluation. Nevertheless, CT detects incidental thyroid nodules (ITNs) and plays an important role in the evaluation of thyroid cancer.

References

  1. "OMIM Entry - % 126900 - DUPUYTREN CONTRACTURE". www.omim.org. Retrieved 5 August 2017.
  2. 1 2 3 4 5 Sharma S, Sharma A (2003). "MRI diagnosis of plantar fibromatosis—a rare anatomic location". The Foot. 13 (4): 219–22. doi:10.1016/S0958-2592(03)00045-2.
  3. Ledderhose G (1894). "Über Zerreisungen der Plantarfascie". Arch Klin Chir. 48: 853–856.
  4. 1 2 "Dupuytren's contracture - Patient UK" . Retrieved 2007-12-27.
  5. 1 2 3 4 5 6 Bunion Busters. "Plantar fibromatosis" . Retrieved 2007-12-27.
  6. 1 2 3 4 5 6 Flatt AE (2001). "The Vikings and Baron Dupuytren's disease". Proc (Bayl Univ Med Cent). 14 (4): 378–84. doi:10.1080/08998280.2001.11927791. PMC   1305903 . PMID   16369649.
  7. 1 2 3 4 5 6 Valentine W. Curran. "Plantar fibromatosis". MedPix. Dept of Radiology and Radiological Sciences, Uniformed Services University. Case 4777. Archived from the original on 2014-11-06. Retrieved 2007-12-28.
  8. 1 2 3 4 Jan Van Der Bauwhede. "Ledderhose Disease: plantar fibromatosis". Wheeless' Textbook of Orthopaedics. Retrieved 2007-12-28.
  9. 1 2 3 4 5 Alan Greene MD FAAP. "Dupuytren's Contracture and Plantar Fibromatosis". Archived from the original on 2008-06-12. Retrieved 2007-12-28.
  10. "Plantar Fibromatosis aka Ledderhose Disease - Foot Pain Explored".
  11. MH Seegenschmiedt, M Wielpütz, E Hanslian, and F Fehlauer "Long-term Outcome of Radiotherapy for Primary and Recurrent Ledderhose Disease" in Ch. Eaton et al. (Eds.) "Dupuytren's Disease and Related Hyperproliferative Disorders" (Springer, Heidelberg & New York, 2012) p 409-428. First time ever reported long-term results (average of 5.5 years of follow-up) link. Also available as ebook.
  12. http://www.dupuytren-online.info/ASTRO_2006/Poster_Ledderhose_ASTRO_06.JPG [ bare URL image file ]
  13. Young, Joseph R; Sternbach, Sarah; Willinger, Max; Hutchinson, Ian D; Rosenbaum, Andrew J (2018-12-17). "The etiology, evaluation, and management of plantar fibromatosis". Orthopedic Research and Reviews. 11: 1–7. doi: 10.2147/ORR.S154289 . ISSN   1179-1462. PMC   6367723 . PMID   30774465.
  14. "Point-Counterpoint: Is Conservative Care The Best Approach For Plantar Fibromatosis?". Podiatry Today. Retrieved 2020-02-10.