Ledderhose's Disease
What is Ledderhose's Disease?
Ledderhose’s disease, also called plantar fibromatosis, is a rare, benign disorder characterized by the abnormal growth within the connective tissue that supports the bottom of the feet, called the plantar aponeurosis. It causes the growth of one or more small, firm lumps usually in the central arch of the foot. This can feel like having small rocks in the bottom of one’s shoes. The main problem is pain and difficulty with walking and wearing footwear. The condition is named after the German surgeon Georg Ledderhose, who described it in 1897. There are 3 recognized stages in the development of plantar fibromatosis:
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Proliferative phase - increasing number of cells creating connective tissue (fibroblasts) in the sole of the foot and very little collagen.
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Active phase - fibroblasts continue to increase, collagen forms, and nodules start to form.
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Residual phase - fibroblasts decrease, collagen growth is rapid and forms noticeable nodules, scar tissue forms and squeezes together causing discomfort.
Synonyms
- Plantar fibromatosis
- Morbus Ledderhose
Ledderhose’s disease, also called plantar fibromatosis, is a rare, benign disorder characterized by the abnormal growth within the connective tissue that supports the bottom of the feet, called the plantar aponeurosis. It causes the growth of one or more small, firm lumps usually in the central arch of the foot. This can feel like having small rocks in the bottom of one’s shoes. The main problem is pain and difficulty with walking and wearing footwear. The condition is named after the German surgeon Georg Ledderhose, who described it in 1897. There are 3 recognized stages in the development of plantar fibromatosis:
-
Proliferative phase - increasing number of cells creating connective tissue (fibroblasts) in the sole of the foot and very little collagen.
-
Active phase - fibroblasts continue to increase, collagen forms, and nodules start to form.
-
Residual phase - fibroblasts decrease, collagen growth is rapid and forms noticeable nodules, scar tissue forms and squeezes together causing discomfort.
Ledderhose’s disease is considered rare, although its true prevalence is uncertain because mild or asymptomatic cases are not brought to medical attention. An U.S. claims-based estimate of 57 cases per 100,000 people has been reported. While it can occur at any age, it is most often diagnosed between ages 30 and 50. Men are affected more often than women, and in 25-50% of patients, the condition may affect both feet. It is more common in people of Northern European descent and may have an association with Dupuytren’s disease affecting the hands.
| Name | Abbreviation |
|---|---|
| Plantar fibromatosis | |
| Morbus Ledderhose |
The precise cause of Ledderhose’s disease is not established. The disease is driven by an abnormal proliferation of collagen-producing myofibroblasts cells. The condition is strongly associated with several risk factors and comorbidities:
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Genetic predisposition: There is often a family history, and the condition is thought to be polygenic. About 14% of people with Ledderhose’s disease also have been diagnosed with Dupuytren’s contracture (tightening of the skin in the hands), implicating Wnt-signaling genes involved in regulating cellular proliferation, differentiation and migration.
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Other factors: Epilepsy, anticonvulsant use, alcohol consumption, liver disease, diabetes, smoking and repetitive trauma to the foot have been associated with the onset of symptoms.
Patients typically present with firm subcutaneous lumps or nodules along the medial or central longitudinal arch of the sole. This can cause pain, swelling, difficulty standing or walking, toes curling towards the bottom of the foot, and inability to straighten the toes.
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Early Stages: The nodules are usually painless and go unnoticed.
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Advanced Stages: As the fibromas enlarge, they often become painful, causing discomfort during walking, standing for long periods, walking barefoot, or wearing restrictive footwear.
Clinical diagnosis is usually sufficient based on patient history and the presence of palpable, firm nodules in the plantar facia and plantar aponeurosis, the connective tissue supporting the heel and arch of the bottom of the foot. Imaging using ultrasound or MRI can be used to confirm and monitor the nodules. Biopsies are infrequently performed and may be done to rule out suspected malignancies.
Because it is a benign condition, treatment heavily favors symptomatic management before considering surgical intervention.
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Conservative Measures: Modification of footwear, use of custom orthotics with padding to offload pressure from the nodule, nonsteroidal anti-inflammatory drugs (NSAIDs), and physical therapy.
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Medical Interventions: Intralesional corticosteroid injections are commonly used to reduce fibroblast activity, inflammation, and nodule size. Other documented medical treatments include topical or injected verapamil (a calcium channel blocker that can suppress collagen production), collagenase injections, and imatinib (a cancer therapeutic drug).
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Adjunctive Therapies: Radiotherapy and extracorporeal shockwave therapy (use of acoustic waves to stimulate local tissues) are employed in some instances to halt progression or reduce symptoms.
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Surgical Treatment: When conservative treatments fail to alleviate severe pain and functional disability, a partial or complete fasciectomy (surgical removal of the fascia and fibromas) may be indicated.
The prognosis with regard to life expectancy is excellent. With conservative care, many patients achieve satisfactory pain relief and functional improvement. However, the course is unpredictable and the condition can be difficult to eradicate completely. Even after surgery, the recurrence rate can be high.
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Tomac, A., Ion, A. P., Opriș, D. R., Arbănași, E. M., Ciucanu, C. C., Bandici, B. C., Coșarcă, C. M., Covalcic, D. C., & Mureșan, A. V. (2023). “Ledderhose’s Disease: An Up-to-Date Review of a Rare Non-Malignant Disorder.” Clinics and Practice, 13(5), 1182-1195. https://doi.org/10.3390/clinpract13050106.
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Young, J. R., Sternbach, S., Willinger, M., Hutchinson, I. D., & Rosenbaum, A. J. (2018). “The etiology, evaluation, and management of plantar fibromatosis.” Orthopedic Research and Reviews, Volume 11, 1–7. https://doi.org/10.2147/orr.s154289.
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Tersago J, Constantin A. (2025). “Soleful solutions: Advancements in treatment strategies for ledderhose disease.” Foot and Ankle Surgery. 31(1):10–14. https://doi.org/10.1016/j.fas.2024.07.008.
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Gudmundsson KG, Jónsson T, Arngrímsson R. Association of Morbus Ledderhose with Dupuytren's contracture. Foot Ankle Int. 2013 Jun;34(6):841-5. doi: 10.1177/1071100713475352. Epub 2013 Feb 5. PMID: 23386754.
Last updated 31 Jul 2010, 10:12 PM
31 Jul 2010, 10:12 PM
Can anyone name a doctor, in Canada or the States or anywhere, who can diagnose Ledderhose or Dupuytren's in the feet? Please!
Last updated 21 May 2010, 09:32 PM
21 May 2010, 09:32 PM
Like you, I consider myself well informed in Plantar Fibromatosis. If you think you are disappointed, you should come to Canada, where they still do not have Cryo for Podiatric surgeries. I have a theory similar to you, that this is auto immune related. I think that the nodules are actually stimulated by exercise. They are hyper tissue growth, like a benign cancer. Its the body's hyper response perhaps to injury. When mine started, I was just starting my nursing career and on my feet for 12 hours a day. I walked everywhere. Now, after 16 years, 2 complete resections both feet, and now cryo, I am lucky I am still walking on my own steam. So far, my faith is in the cryo, because as far as I know Xiaflex is not for Plantar Fibromas. I had cryo about 12 weeks ago, and it got me back walking and on less pain meds. Yes, grafting is known to discourage tumor regrowth, but the extensive recovery is not an option, as I have equal problems in both feet. I am glad that you are finding some options. I do not know if you are also part of the Plantar Fibromatosis web group on Yahoo, but there are more members and lots of info. Good Luck! Susan
18 Aug 2009, 10:14 PM
I'd like to know the treatment options considered by the members here. Please share what you're doing, other than surgery. Below is my own history with the disease. I'm a 46 year old woman with Ledderhose, diagnosed when I was 29 yrs old. My father has Dupuytren's. I am currently hobbling around on crutches as I had 3 tumors removed from my right foot two weeks ago; the size of tissue removed was about 2 1/2 to 3 inches long by 1 inch wide. This time (this is my third surgery with large Ledderhose tumors), I am being treated by a talented young Podiatrist/surgeon who used human tissue (grown in the lab) to replace the space of the tumors. This doctor has had very good success in zero repetition of the tumors after using the foreign skin (of course he also is taking a clean margin around the tumors as well, a well known technique to prevent reaccurance). I will say that I consider myself a near-expert in Ledderhose, since I have needed 3 surgeries in the past 17 years to live a semi-normal life. I have had Hashimoto's disease (thyroid-auto-immune) since I was 19 years old, but it was not treated until I was 38 years old, when I finally got very very sick. I also have the auto-immune variety of Arthritis. My endocrynologist (an extremely talented woman) knows nothing of Ledderhose. I WISHED that there was one doctor who could treat all of this auto-immune stuff (including Ledderhose, which I believe is auto-immune), but I have not found a doctor who could do this. So...the Podiatrist for Ledderhose, the Endocrynologist for the Hashimoto's, and the Rhumatologist for the arthritis. What no one has ever told me (because no one knows) is WHY. I will say that I am quite dissappointed that in the USA, the NIH (the National Institute of Health--the government agency for medical research) has put exactly ZERO dollars towards research of Ledderhose. Other tumors: I should note that I currently have fibroid tumors in my uterous and one of my lungs, and no doctor can tell me why. I do have an appt with a lung doc in Sep 09 to pursue diagnosis. Background: My first tumor was very large (left foot), and at the time I was an extremely fit 29 year old woman, a vegetarian (I do not believe that diet plays any part in Ledderhose) running 6 miles a day 6 days a week. The tumor went from a pea size to 2 inches in one month (left foot); surgery was the only option. The doc took a clean margin of tissue around the tumor. Tumor never reacurred in this foot. My second tumor was in 2004 (right foot), it was about 1/2 inch in diameter on the right foot. The doctor never took a clean margin around the tumor. Tumor reacurred in 2008, in multiples in right foot. Aug 2009 are latest tumors (3 of them) in the right foot (explained above).
Last updated 20 May 2010, 04:00 PM
20 May 2010, 04:00 PM
Dupuytrens Contracture has a website and gives information on XIAFLEX unfortunately it deals more with the chords not the nodules. So not an option for us. Please take a read though lots of great information. I have both Ledderhose in both feet and Dupuytrens in both hands. I am just a patient but have researched this alot and wished I would have prior to surgery. !!! I hope this helps you.
20 Apr 2010, 09:44 PM
I was diagnosed with Plantar's Fibroma in 2003 with a tumor about the size of a pea in the right foot with no pain at the time. Since that time, I have a second tumor on the right foot and one large tumor on the left foot. I am now starting to experience pain when standing or walking for an extended length of time. My father had Dupuytren's Contracture in his hand and I guess passed the gene to me. I am now at a time where a decision needs to be made as to surgery or the new injection of Xiaflex. Does anyone know anything about this?
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Created by Inger | Last updated 31 Jul 2010, 10:12 PM
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