Surgery for Ledderhose

Surgery is indicated in severe cases where there is constant pain and difficulty in walking. The surgery entails removing the affected tissues and surrounding fascia.

Recurrence after surgery is high and the disease can be more aggressive than before. Sometimes, all the fascia of the foot is removed. This will result in a flat arch and affect normal gait.

Potential complications of surgery include swelling, haematoma, infection, and formation of a painful scar.

We have a special YouTube channel for our webinars and videos. Here specialists explain more about the different treatment options and the rationale behind them, as well as what might be possible in the future.    The channel can be found here:

British Dupuytren’s Society YouTube channel

The webinars we have done are:

1/ Dupuytren’s disease and surgical treatments
2/ Percutaneous needle fasciotomy for Dupuytren’s
3/ Dupuytren’s Research updates
4/ Ledderhose Disease

 

Surgery for Ledderhose disease

Surgery for Ledderhose disease is only recommended in severe cases i.e. when there is constant pain and difficulty walking, but it is still an option that should be considered.

To our knowledge surgery is the only treatment for Ledderhose which actually results in total removal of nodules. Most specialists consider surgery as the last resort, as the foot is weight bearing and this can result in multiple complications, including swelling, haematoma, infection, the chance of recurrence and the formation of a painful scar.

There are two main types of surgery performed for Ledderhose, each having their own benefits and drawbacks:

Nodule Removal

With this type of surgery only the nodule is removed. This surgery is the least invasive, offers the quickest recovery time and has the lowest complication rate, however it does have a very high rate of recurrence of nodules. The exact rate at which they reappear is unknown, but some reports place the figure as high as 85% (Durr et al 1999, Sammarco and Mangone 2000). There have been reports from some patients, that post-surgery their nodules grow faster and are more painful, whilst others are happy with the results.

Fascia Removal

With this type of surgery the entire fascia is removed from the bottom of the foot in order to greatly reduce the level of recurrence. This does result in less chance of the nodules coming back, but also has increased complications. Not only is the recovery time much longer with months having to be spent on crutches, but the patient is likely to have to use orthotics for the remainder of their life, and may suffer from flat arches that affect normal gait, and there is still going to be scar tissue formation.

More information can be found on a UK Ledderhose patient’s blog.

Where is the treatment available in the UK?

For a list of doctors and clinics that we have heard of as having a special interest in Ledderhose please see our page ‘Doctors, Clinics and Organisations’.