Definition
Fibrous proliferative lesion in plantar fascia
Ledderhose disease
Epidemiology
Rare < 1/200,000
Men > women
Middle aged
Bilateral 25%
Associations - Dupuytren's disease, Peyronie's disease
Pathology
Usually affects medial and central bands of plantar fascia
Proliferative Fibroblastic lesion
- heavy strands of relatively acellular mature collagen
- may resemble fibrosarcoma histologically
Enneking 3 Stages
- proliferative phase - fibroblasts
- active phase - nodule formation
- residual phase - collagen maturation
Clinical picture
Slow growing nodule in medial or central plantar fascia
- doesn't involve skin
- rarely associated with contractions
As gets bigger, pain with walking / shoewear
MRI
Focal oval shaped lesions within the plantar fascia
Differential diagnosis
Neurofibroma / neurilemmoma
Fibrosarcoma / other sarcomas
Nonoperative management
Steroid injection
Verapamil
Radiation therapy
ECSW
Collagenase
Operative management
Options
Local resection
Wide resection
Anwander et al Foot Ankle Spec 2024
- systematic review of recurrence rates after surgery
- local resection 67%
- wide resection 42%
- fasciectomy 27%
Problems
May recur after excision
- usually after incomplete / simple excision
- can recur & become locally invasive
- doesn't metastasise or become locally destructive
Technique Wide resection
Position
- prone
- tourniquet
Incision
- S shaped
- avoid 1st MT head
- avoid weight bearing arch
- minimise disruption of blood supply
- usual medial longitudinal incision interrupts most of the arterial supply to the skin beneath the longitudinal arch
Block resection of plantar fascia
- 2 cm normal fascia proximal and distal
- entire width
- lateral plantar nerve is adherent to fascia on lateral side
Recurrence
Consider radiotherapy