Ledderhose disease treatment
Many people with Ledderhose initially cope by making changes to their footwear, along with gentle stretching, massage and icing of the soles of the affected foot. If the nodules grow to the extent that walking or standing is painful then further treatment options should be investigated. There is no NICE guidance for treatment on the NHS of Ledderhose or Plantar Fibromatosis
Please watch our webinar which explains about the different treatment options.
Treatment will depend on the severity of the disease, and may include:
Steroid injections: injected into the lumps: this can shrink the lumps and reduce the pain.
Physiotherapy: stretching exercises, massage, and splints to prevent contractures or stiffening of the foot.
Orthotics: special inserts in shoes may reduce pressure on the lump and reduce pain when walking.
Soft arch supports and padding help cushion the nodules. Holes can be cut in the inserts to reduce pressure on the nodules.
Ledderhose is probably due to a combination of genetic and environmental factors.
Mechanical strain in the CT band (calf to toes muscles and tendons) may be one factor. If this is the case, then reducing the strain with calf stretches
exercises) or heel lifts (inserts) could help. This will not cure Ledderhose, but may make the symptoms less painful (and is a lot less invasive than surgery).
If you wish to follow this route, consult a podiatrist or foot care professional.
Radiotherapy to stop the progression of the disease and sometimes shrink the lumps. Available both private and in some centra on the NHS (see our doctors page ). Radiotherapy has helped some patients live pain free or virtually pain free again. For more explanation see our page on Radiotherapy for Ledderhose
Side effects can be some redness and tenderness, sometimes even one or two weeks after the treatment, and dryness of the treated skin. Cases of post-radiation cancer have never been described and the risk is minimal as the dose of radiation is far less than what is used for cancer treatments. Radiation treatment is gaining popularity with patients in Europe and the US.
Surgery is usually performed only as a last resort if the size of nodules prevent walking or are very painful. Recurrence of the nodules or new growth is common. Also a hard scar may result which can be just as painful as the original nodules.
Our partner site provides a more comprehensive discussion on the options for treating Ledderhose.
Alternative treatments (not available in the UK on NHS):
Collagenase (Xiapex) injections have been tried but the results were not convincing.
Hyaluronidase injections: increasingly popular though to date (May 2020) not used in the UK. The drug is mixed with a steroid and sometimes a local anaesthetic, and injected into the plantar fibroma (lump). This helps soften the nodule and shrink it, and maybe change the tissue around the nodule so the cells are no longer stimulated to grow. Several injections are usually needed, given 3-4 weeks apart each time. It is not a cure as the underlying (genetic) cause still exists so recurrence is possible. Our webinar explains more about this treatment. It has been used mainly in the USA by podiatrists.
Verapamil: gel has been used in the USA. As for Peyronie’s disease the cost seems to be the biggest problem. Its effectiveness is not proven. it can be obtained in the UK as special order from the USA but only private and is costly.
Cryosurgery: freezing the affected tissue, by inserting probes in it and cooling the probes to a temperature where the tissue will die. This treatment is approved by the FDA for use in the U.S. YouTube video.
It is possible to have cryosurgery done private in the UK.
Anti inflammatory or anti- rheumatic: drugs to reduce pain and inflammation.
Extra corporeal shockwaves: therehas been a trial in Germany to assess the effect of this treatment but the results were not encouraging for many patients. It is not performed in the UK for Ledderhose (but is used for Plantar Fasciitis).
Imiquimod (a cream that softens lumps, sold under the brand name of Aldara) was being tried by several Ledderhose sufferers back in 2006, but we haven’t seen any mention of successful results, so it is probably ineffective for Ledderhose.
Podiatry Today (US) article on handling Ledderhose disease.
One persons personal experience of living with Ledderhose disease. This includes discussions on the options for a treatment and a personal account of treatment via Radiotherapy in the UK, and interviews with other patients.
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:
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