scholarly journals Dupuytren-Like Contracture of the Foot: Ledderhose Disease

2016 ◽  
Vol 02 (03) ◽  
pp. e102-e104 ◽  
Author(s):  
Osman Akdag ◽  
Gokce Yildiran ◽  
Mehtap Karamese ◽  
Zekeriya Tosun
Keyword(s):  
Treatment Options ◽  
Plantar Fascia ◽  
Plantar Aponeurosis ◽  
Steroid Injections ◽  
Medial Side ◽  
Disease Case ◽  
Ledderhose Disease ◽  
Plantar Incision ◽  
Plantar Fibromatosis ◽  
Slow Growing

Introduction Plantar fibromatosis is a rare hyperproliferative disease of plantar aponeurosis and is also called Ledderhose disease. Case properties and treatment are discussed in this report. Case Report A 30-year-old man presented with painful bilateral plantar nodules. He had multiple and bilateral fixed and solid nodules on the plantar and medial side of his feet measuring 1 cm each. Ultrasound was performed and hypoechoic homogeneous nodules were detected. The patient underwent surgery, and the nodes were removed via a plantar incision with 2-cm safety distance. Discussion Ledderhose disease is a rare, hyperproliferative disorder of the plantar aponeurosis. The nodules are slow growing and found in the medial part of the plantar fascia. The precise etiology remains unknown. The treatment options are conservative management, steroid injections, radiotherapy, and surgery. Conclusion The main cause of this disease remains uncertain. Related conditions should be evaluated, and a patient who presents with Dupuytren or Peyronie disease should also be investigated for Ledderhose disease.

Plantar Fibromatosis: Pathophysiology, Surgical and Nonsurgical Therapies: An Evidence-Based Review

2018 ◽  
Vol 11 (2) ◽  
pp. 168-176 ◽  
Author(s):  
Paul Carroll ◽  
Robert M. Henshaw ◽  
Caitlin Garwood ◽  
Katherine Raspovic ◽  
Dhruv Kumar
Keyword(s):  
Symptomatic Relief ◽  
Treatment Options ◽  
Plantar Fascia ◽  
Unknown Etiology ◽  
Morbus Ledderhose ◽  
Investigational Therapies ◽  
Promising Treatment ◽  
Extra Abdominal Desmoid ◽  
Plantar Fibromatosis ◽  
Slow Growing

Plantar fibromatosis (morbus Ledderhose), an extra-abdominal desmoid tumor of the plantar foot, is a rare benign hyperproliferative disorder of the plantar fascia with an unknown etiology. The main clinical characteristics include slow growing nodules on the medial and central bands of the plantar fascia, which may become painful and negatively affect ambulation. Most established conservative therapies today target symptomatic relief. As symptoms progress, therapies such as injections, shockwave ablation, radiation, and/or surgery may be required. This review aims to provide insight into the pathophysiology of this condition in addition to detailing current and investigational therapies for this disorder. Many therapies have been proven in similar conditions, which could lead to promising treatment options for plantar fibromatosis. Levels of Evidence: Level V: Expert opinion

scholarly journals Ledderhose Disease: Clinical, Radiological (Ultrasound and MRI), and Anatomopathological Findings

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Y. Omor ◽  
B. Dhaene ◽  
S. Grijseels ◽  
S. Alard
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Clinical Examination ◽  
Middle Age ◽  
Resonance Imaging ◽  
Plantar Aponeurosis ◽  
Ledderhose Disease ◽  
Magnetic Resonance Imaging Mri ◽  
Plantar Fibromatosis

Plantar fibromatosis, or Ledderhose disease, is a rare hyperproliferative disorder of the plantar aponeurosis. It may occur at any age, with the greatest prevalence at middle age and beyond. This disorder is more common in men than woman and it is sometimes associated with other forms of fibromatosis. Diagnosis is based on clinical examination. Ultrasound (US) and magnetic resonance imaging (MRI) can be useful to confirm the diagnosis. A 44-year-old man with Ledderhose disease who underwent ultrasound and MR is described in this paper.

Ultrasound-Guided Injection of Dextrose Versus Corticosteroid in Chronic Plantar Fasciitis Management: A Randomized, Double-Blind Clinical Trial

2021 ◽  
pp. 193864002098092
Author(s):  
Gholamreza Raissi ◽  
Amin Arbabi ◽  
Maryam Rafiei ◽  
Bijan Forogh ◽  
Arash Babaei-Ghazani ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Plantar Fasciitis ◽  
Rating Scale ◽  
Corticosteroid Injection ◽  
Treatment Options ◽  
Plantar Fascia ◽  
Numeric Rating Scale ◽  
Therapeutic Effects ◽  
Ultrasound Guided ◽  
Double Blind

Design Chronic plantar fasciitis (PF) is a common cause of chronic heel pain, with different conventional treatment options. In this randomized clinical trial, the effect of ultrasound-guided injection of dextrose versus corticosteroid in chronic PF was evaluated and compared. Methods A total of 44 patients suffering from chronic PF who visited the physical medicine and rehabilitation clinic were enrolled in the study. Two table-randomized groups were formed. They received an ultrasonography-guided, single injection of either 40 mg methylprednisolone or 20% dextrose. Numeric Rating Scale (NRS), Foot and Ankle Ability Measure questionnaire with 2 subscales, Activities of Daily Living (FAAM-A) and Sports (FAAM-S), along with ultrasonographic parameters were evaluated before and at 2 and 12 weeks after the injection. Results. A total of 40 participants completed the study. Both interventions significantly improved pain and function at 2 and 12 weeks postinjection. After 2 weeks, compared with the dextrose prolotherapy, the corticosteroid group had significantly lower daytime and morning NRS scores (2.55 vs 4.1, P = .012, and 2.75 vs 4.65, P = .004), higher FAAM-S (66.84 vs 54.19; P = .047), and lower plantar fascia thickness at insertion and 1 cm distal to the insertion zone (3.89 vs 4.29 mm, P = .004, and 3.13 vs 3.48 mm, P = .002), whereas FAAM-A was similar in both groups ( P = .219). After 12 weeks, all study variables were statistically similar between corticosteroid and dextrose prolotherapy groups. No injection-related side effects were recorded in either group. Conclusion Both methods are effective. Compared with dextrose prolotherapy, our results show that corticosteroid injection may have superior therapeutic effects early after injection, accompanied by a similar outcome at 12 weeks postinjection. Levels of Evidence: Level II

scholarly journals Gastric Schwannoma: A Rare but Important Differential Diagnosis of a Gastric Submucosal Mass

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
William Yoon ◽  
Kari Paulson ◽  
Paul Mazzara ◽  
Sweety Nagori ◽  
Mohammed Barawi ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Surgical Resection ◽  
Treatment Options ◽  
Partial Gastrectomy ◽  
Preoperative Imaging ◽  
Mesenchymal Tumors ◽  
Gastric Schwannoma ◽  
Gastric Mass ◽  
Submucosal Mass ◽  
Slow Growing

Schwannomas are generally slow growing asymptomatic neoplasms that rarely occur in the GI tract. However, if found, the most common site is the stomach. Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, and 60–70% of them occur in the stomach. Owing to their typical presentation as submucosal neoplasms, gastric schwannomas and GISTs appear grossly similar. Accordingly, the differential diagnosis for a gastric submucosal mass should include gastric schwannomas. Furthermore, GI schwannomas are benign neoplasms with excellent prognosis after surgical resection, whereas 10–30% of GISTs have malignant behavior. Hence, it is important to distinguish gastric schwannomas from GISTs to make an accurate diagnosis to optimally guide treatment options. Nevertheless, owing to the paucity of gastric schwannomas, the index of suspicion for this diagnosis is low. We report a rare case of gastric schwannoma in 53-year-old woman who underwent laparoscopic partial gastrectomy under the suspicion of a GIST preoperatively but confirmed to have a gastric schwannoma postoperatively. This case underscores the importance of including gastric schwannomas in the differential diagnosis when preoperative imaging studies reveal a submucosal, exophytic gastric mass. For a gastric schwannoma, complete margin negative surgical resection is the curative treatment of choice.

Proximal Medial Longitudinal Arch Incision for Plantar Fascia Release

Foot & Ankle ◽  
1987 ◽  
Vol 8 (3) ◽  
pp. 152-155 ◽  
Author(s):  
William G. Ward ◽  
Frank W. Clippinger
Keyword(s):  
Plantar Fasciitis ◽  
Tibial Nerve ◽  
Plantar Fascia ◽  
Surgical Approaches ◽  
Medial Longitudinal Arch ◽  
Posterior Tibial Nerve ◽  
Posterior Tibial ◽  
Longitudinal Arch ◽  
Plantar Incision ◽  
Plantar Fascia Release

A curved, oblique plantar incision in the proximal aspect in the medial longitudinal arch was used to release the plantar fascia in eight feet with recalcitrant plantar fasciitis. Seven feet became pain free and the eighth was 75% improved. Normal sensation to the heel was preserved in all cases. No painful scars or neuromas of the calcaneal branch of the posterior tibial nerve developed. This approach represents a significant improvement over previously reported surgical approaches.

scholarly journals Plantar fibromatosis and Dupuytren’s contracture in an adolescent

2011 ◽  
Vol 68 (10) ◽  
pp. 886-890
Author(s):  
Jelena Nikolic ◽  
Zlata Janjic ◽  
Dragan Momcilovic ◽  
Srdjan Ninkovic ◽  
Vladimir Harhai
Keyword(s):  
Plantar Fascia ◽  
Metacarpophalangeal Joint ◽  
Tumor Biopsy ◽  
Clinical Exam ◽  
Pip Joint ◽  
Palmar Aponeurosis ◽  
Proliferative Disease ◽  
Wide Group ◽  
Plantar Fibromatosis ◽  
Adolescent Period

Background. Fibromatosis represents a wide group of benign, locally proliferative disorders of fibroblasts. Dupuytren` s disease is a benign proliferative disease of palmar aponeurosis which usually affects adults between 40 and 60 years of age. Ledderhose`s disease or plantar fibromatosis is plantar equivalent of Dupuyten`s disease most often affecting middle- aged and older men, usually bilateral, represented with painless nodule in the medial division of plantar fascia. Case report. We presented a 19-year old adolescent that turned to a plastic surgeon complaining to his small finger contracture. He noticed palmar thickening with nodule over the metacarpophalangeal joint of small finger of his right hand when he was 16 years old. A year later a finger started to band. During physical checkup we noticed plantar nodule that also had his father and grandmother. Magnetic resonance and tumor biopsy confirmed a suspicion on plantar fibromatosis - Ledderhose`s disease. Clinical exam of the hand clearly led to a conclusion that the patient had Dupuytren`s contracture with pretendinous cord over the small finger flexor tendons and lack of extension of proximal interphalangeal (PIP) joint. On the extensor side of the PIP joints there were Garrod`s nodes. The patient refused surgical treatment of plantar tumor, but agreed to surgical correction of finger contracture. Conclusion. Despite the fact that Dupuytren`s disease and plantar fibromatosis are diseases of adults, the possibility of conjoint appearance of these forms of fibromatosis in adolescent period of life should be kept in mind especially in patients with strong genetic predisposition.

scholarly journals Surgical Treatment of Ledderhose Disease in Patient with Mucopolysaccharidosis Type I (Hurler-Sheie)

2015 ◽  
Vol 22 (1) ◽  
pp. 81-83
Author(s):  
N. A Koryshkov ◽  
L. K Mikhailova ◽  
A. S Khodjiev
Keyword(s):  
Surgical Intervention ◽  
Weight Bearing ◽  
Type I ◽  
Mucopolysaccharidosis Type ◽  
Mucopolysaccharidosis Type I ◽  
Plantar Aponeurosis ◽  
Enzyme Replacement ◽  
Ledderhose Disease ◽  
Early Surgical Intervention

Case report of a 29 years old female patient with mucopolysaccharidosis type I and Ledderhose disease is presented. Examination of plantar surfaces showed tumor like protrusions up to 6.5 cm, of irregular shape and extremely painful at palpation, on both feet. Resection of plantar aponeurosis and fibrotic nodes on both feet was performed against a background of pathogenetic enzyme replacement therapy. No complications were observed in postoperative period. This case illustrates that in such patients performance of early surgical intervention at specialized departments is possible and reasonable, as it enables to restore weight bearing ability of the foot as well as significantly increases the quality of life.

scholarly journals Calcaneal Osteotomy “Safe Zone” for Avoiding Injury to the Lateral Plantar Artery: A Fresh Cadaveric Study

2020 ◽  
Author(s):  
Ichiro Tonogai ◽  
Koichi Sairyo ◽  
Yoshihiro Tsuruo Tsuruo
Keyword(s):  
External Iliac Artery ◽  
Plantar Fascia ◽  
Safe Zone ◽  
Cadaveric Study ◽  
Medial Side ◽  
Calcaneal Osteotomy ◽  
Plantar Artery ◽  
Perpendicular Distance ◽  
Risk Of Rupture ◽  
Enhanced Computed Tomography

Abstract Background Calcaneal osteotomy is used to correct hindfoot deformity. Pseudoaneurysms of the lateral plantar artery (LPA) have been reported following calcaneal osteotomy and are at risk of rupture. The vascular structures in close proximity to the calcaneal osteotomy have variable courses and branching patterns. However, there is little information on the “safe zone” during calcaneal osteotomy. This study aimed to identify the safe zone that avoids LPA injury during calcaneal osteotomy.Methods Enhanced computed tomography scans of 25 fresh cadaveric feet (13 male and 12 female specimens; mean age 79.0 years at time of death) were assessed. The specimens were injected with barium via the external iliac artery. A landmark line (line A) connecting the posterosuperior aspect of the calcaneal tuberosity and the origin of the plantar fascia was drawn and the shortest perpendicular distance between the LPA and line A was measured on sagittal images.Results The average perpendicular distance between the LPA and line A at its closest point was 15.2 ± 2.9 mm. In 2 feet (8.0%), the perpendicular distance between the LPA and line A at its closest point was very short (approximately 9 mm). In 18 of the 25 feet (72.0%), the point where the perpendicular distance from line A to the LPA was closest was the bifurcation of one of the medial calcaneal branches of the LPA, and in 7 feet (28.0%) the shortest perpendicular distance from line A to the LPA was the trifurcation of the LPA, medial plantar artery, and one of the medial calcaneal branches.Conclusion Calcaneal osteotomy performed more than 9 mm from line A could damage the LPA by overpenetration on the medial side. Calcaneal osteotomy on the medial side should be performed with caution to avoid iatrogenic injury to the LPA.Level of Evidence: IV, cadaveric study

Role of the plantar fascia in digital stabilization. A case report

1996 ◽  
Vol 86 (1) ◽  
pp. 43-47 ◽  
Author(s):  
J Pontious ◽  
KP Flanigan ◽  
HJ Hillstrom
Keyword(s):  
Case Report ◽  
Postoperative Complication ◽  
Plantar Fascia ◽  
Plantar Aponeurosis ◽  
Longitudinal Arch ◽  
Ligamentous Structure ◽  
Hammer Toes

The plantar aponeurosis is a ligamentous structure that extends from the calcaneus to the proximal phalanges. Under tension, it functions to support the longitudinal arch, supinate the rearfoot, and stabilize the digits against the ground. The anatomy and biomechanics of the plantar fascia and plantar aponeurosis, particularly their role in digital stabilization, are reviewed. A case is presented showing a patient who developed hammer toes as a postoperative complication after having a portion of the plantar aponeurosis removed.

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