pathology: Ledderhose disease

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Ledderhose disease

Definition of

Also known as fibromatosis plantae, in the vast majority of cases oligo- or multifocal benign fibromatosis (excessive proliferation of spindle cells with collagen deposition) of the plantar fascia, a disease similar to Dupuytren’s contracture of the hand, except that flexion contractures of the toes are far less common. Familial disposition, usually progressive in phases. In simple cases, the diagnosis can be made clinically; in advanced cases, an MRI or high-resolution ultrasound may be indicated. Peak cases: middle-aged or older white men, often accompanied by Dupuytren’s contracture or induration penis plastica. Hard and tight shoes increase the pain. Standing time and walking distance may be limited. In severe cases, the skin may also be affected and nodules may grow into the skin. Onset usually between the ages of 20 and 50. Early onset appears to predispose to more severe courses (more aggressive juvenile aponeurotic form), in which the skin may also be affected and the fibromatosis extends into the connective tissue between the foot muscles. Men are affected earlier (approx. one decade, 40 – 50 years of age) than women (50 – 60 years of age). The affected areas can become significantly larger than in Dupuytren’s and restrict the ability to walk. Trauma can have a triggering function. The probability of developing Dupuytren’s contracture in the presence of Ledderhose disease is much higher than vice versa. It is divided into stages/grades:

  1. monofocal in the center of the plantar fascia
  2. oligofocal in the plantar fascia
  3. Infestation of the skin or tendon sheaths
  4. Infestation of the skin and tendon sheaths

Stage 3 usually shows pronounced symptoms, stage 4 is then already difficult to treat.

Cause

unknown

Predisposing

  1. Alcohol abuse
  2. Nitotine consumption
  3. Diabetes mellitus
  4. Metabolic diseases
  5. persistent herpes zoster
  6. various medications such as barbiturate antiepileptic drugs, etc.
  7. Running and sports with intensive use of the legs seem to be more likely: Tennis, soccer, basketball, dancing,.
  8. familial disposition

Symptoms

The symptoms range from individual palpable but painless or only slightly painful nodules to involvement of a large part of the plantar fascia between the calcaneus and hallux.

Therapy

  1. An asymptomatic course requires no therapy. It is not uncommon for the lumps to remain unchanged for years.
  2. NSAIDs or other anti-inflammatory drugs
  3. Insoles to protect the affected area
  4. Soft X-rays
  5. Shock wave therapy
  6. Cortisone infiltrations
  7. Collagenase infiltrations
  8. Surgery generally only if and because of sufficient pain or transition to stage 3 or 4. Recurrences in 60%, depending on the extent of the excision. If necessary, partial to total fasciectomy, then low risk of recurrence, but greater risk of wound healing disorder and infection. Risk of nerve injury. The option of fibrosis perforation, which is important in Dupuytren‘ s contracture, does not play a role here as flexion contractures rarely occur.
  9. Stretching and fascia roll
  10. Foot gymnastics
  11. Barefoot running on changing and uneven surfaces
  12. Massaging the lumps can reduce them

DD

  1. Plantar fasciitis
  2. Tarsal tunnel syndrome
  3. Occult calcaneal fracture
  4. Apophysitis calcanei (usually before puberty, due to sporting overuse)

Asana practice

In terms of movement therapy, the focus with this condition is on maintaining flexibility and regular, moderate and varied movement of the foot and toes. On the one hand, the fascia roll is ideal for keeping the intrinsic foot muscles flexible as an active tension belt and also for keeping the plantar fascia and ligaments such as the plantar long ligament flexible or making them more flexible as a passive tension belt and reducing the often increased tone of the muscles, especially in athletes. Stretches of the intrinsic plantar foot muscles, which bend the toes in a plantar direction, can be performed well in postures with the toes pressed against the wall and the sole of the foot resting on the floor, such as setu bandha sarvangasana against the wall. It also makes sense to work on the entire muscle chains and to stretch the soleus and gastrocmenius, i.e. to perform calf stretches with the knee joint extended and with the knee joint flexed. Muscular imbalances that negatively affect the statics and kinetics of the lower extremities should also be eliminated, as they can lead to underutilization or overloading of muscles and ligaments.

Asanas

Asanas in 971: Stretching the toe flexors
Asanas in 851: Stretching the foot extensors(triceps surae, plantar flexors / calf muscles)
Asanas in 856: Stretching the gastrocnemius