Ledderhose disease

The first mention of the condition in the medical literature is in the clinical lectures of G. Dupuytren, who after discussing the palmar contracture named after him states:

When opportunity presents, we shall speak of retraction of the toes, which is also caused by a crisping of the plantar aponeurosis (Dupuytren 1832).

Unfortunately the opportunity did not arise before Dupuytren’s death in 1834.

The first detailed description is by Georg Ledderhose (Ledderhose 1894). He describes 10 patients between 25 and 48 years old with a plaster cast on their lower leg and foot, who developed pain in the foot. Georg Ledderhose found swelling in the plantar fascia which was very painful to touch. He describes it as a spindle-like swelling, and 5-12 months after the swelling is still present. None of these patients showed signs of Dupuytren Disease in their hands. Some patients reported the pain and swelling started immediately after the trauma to their foot or ankle, others noticed it while their leg was in a cast. After removal of a nodule he checked it microscopically and found it was in the plantar fascia, and speculated that trauma to the plantar fascia was the reason for the nodule formation , and decided to name his publication “Über Zerreissungen der Plantarfascie”, i.e. “on tears in the plantar fascia” (Ledderhose 1894).

By 1897 Ledderhose had seen 50 cases, and now considered it a similar or the same disease as Dupuytren’s disease. He speculated that less circulation and nutrition to the plantar fascia after trauma and immobilisation of the foot and ankle led to plantar fasciitis, and proliferation of fascia cells. This corrected sometimes after normalising the circulation but not in all cases, and some developed a fibroma, mostly in the medial fascia. In some cases these nodules regressed spontaneously after months or years, but some did not. In a few cases he even observed contraction of the fascia. Ledderhose removed 5 nodules and did not see recurrence up to 3.5 years later. Microscopically he observed fibroblasts and other cells of the connective tissue. He also saw spindle cells and pigment cells in the preparations (Ledderhose 1897).

Research since then has been case studies mainly, with patient numbers varying typically between one and ten. Not much research has been done into the immune histochemistry of Ledderhose tissues, instead it is generally assumed to be the same as Dupuytren’s tissues. Very few clinical trials or studies into different treatments have been done so far, mostly investigating radiotherapy.