Radiation Therapy of a Case of Ledderhose’s Disease: A Rare Benign Nodule of the Plantar Aponeurosis


Authors : M. Taouchikht; S. Abdou; H. Fares; K. Nouni; A. Lachgar; H. El Kacemi; T. Kebdani; K. Hassouni

Volume/Issue : Volume 9 - 2024, Issue 9 - September


Google Scholar : https://tinyurl.com/2tjb56na

Scribd : https://tinyurl.com/2km9avaw

DOI : https://doi.org/10.38124/ijisrt/IJISRT24SEP387

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Abstract : Ledderhose’s disease, or plantar fibromatosis, is a rare benign condition characterized by the excessive proliferation of connective tissue in the plantar aponeurosis, leading to slow-growing nodules. Although it usually presents unilaterally, bilateral involvement occurs in about 25% of cases. The exact cause is unknown, but associations with diabetes mellitus, liver disease, and repeated trauma have been noted. Treatment options are diverse, with surgery often being the primary approach, but radiation therapy has emerged as a promising alternative. We present the case of a 70-year-old Moroccan man with a painful plantar nodule, diagnosed with Ledderhose’s disease. Initial measures were insufficient, leading to the use of radiation therapy. The patient received Three-Dimensional Conformal Radiotherapy (3D-CRT) at a dose of 30.0 Gy, administered in two courses. Following treatment, the patient experienced significant symptom relief and a notable reduction in nodule size. Although surgery was eventually required due to disease progression, it is noteworthy that radiation therapy effectively delayed the need for surgical intervention.

References :

  1. Ledderhose G. Zur Pathologie der Aponeurose des Fußes und der Hand. Langenbecks Arch Klin Chir 1897;55:694–712.
  2. S. Banerjee, M. Muhammad, C. Nath, and D. Kumar Pal, “Plantar fibromatosis: a case report,” The Foot and Ankle Online Journal, vol. 2, no. 12, article 3, 2009.
  3. Kashuk KB, Pasternack WA. Aggressive infiltrating plantar fibromatosis. J Am Podiatry Assoc 1981;70:491–6.
  4. D. F. de Souza, L. Micaelo, T. Cuzzi, and M. Ramos-e-Silva, “Ledderhose disease—an unusual presentation,” Journal of Clinical and Aesthetic Dermatology, vol. 3, no. 9, pp. 45–47, 2010.
  5. A. L. Van Rijssen and P. M. N. Werker, “Percutaneous needle fasciotomy in Dupuytren’s disease,”The Journal of Hand Surgery, vol. 31, no. 5, pp. 498–501, 2006.
  6. E. de Bree, F. A. N. Zoetmulder, R. B. Keus, H. L. Peterse, and F. Van Coevorden, “Incidence and treatment of recurrent plantar fibromatosis by surgery and postoperative radiotherapy,” The American Journal of Surgery, vol. 187, no. 1, pp. 33–38, 2004.
  7. Bruno Gonçalves Schröder e Souza, “Surgical Treatment of a Case of Ledderhose’s Disease: A Safe Plantar Approach to Subtotal Fasciectomy” Case Reports in Orthopedics Volume 2015.
  8. Beckmann, Kalteis T, Baer W, et al. Plantarfibromatose: Therapie mit totaler Plantarfasziektomie. Zentralbl Chir 2004;129:53–7.
  9. Seegenschmiedt MH, Attassi M. Strahlentherapie beim Morbus Ledderhose – Indikation und klinische Ergebnisse. Strahlenther Onkol 2003;179:847–53.
  10. Heyd, R., Dorn, A. P., Herkströter, M., Rödel, C., Müller-Schimpfle, M., & Fraunholz, I. (2009). Radiation Therapy for Early Stages of Morbus Ledderhose. Strahlentherapie Und Onkologie, 186(1), 24–29.
  11. M.L. Smith, C.L. Matthiesen, A.N. Arain, T.S. Herman .The Efficacy of Radiation Therapy for Dupuytren’s Contracture and Morbus Ledderhose (2015). International Journal of Radiation Oncology,  ASTRO
  12. Radiation Therapy Oncology Group. Acute radiation morbidity scoring criteria http://www.rtog.org/ResearchAssociates/AdverseEventReporting/AcuteRadiationMorbidityScoringCriteria. aspx
  13. M. Trybus, M. Bednarek, P. Budzynski, M. Gniadek, and J. Lorkowski, “Concomitance of Ledderhose's disease with Dupuytren's contracture. Own experience,” Przegląd Lekarski, vol. 69, no. 9, pp. 663–666, 2012.
  14. E. A. Oliveira, T. Pato, and A. Barcelos, “Ledderhose disease—a clinical case,” Acta Reumatologica Portuguesa, vol. 35, no. 4, pp. 529–530, 2010.
  15. H. R. Dürr, A. Krödel, H. Trouillier, A. Lienemann, and H. J. Refior, “Fibromatosis of the plantar fascia: diagnosis and indications for surgical treatment,” Foot and Ankle International, vol. 20, no. 1, pp. 13–17, 1999.
  16. A. M. Halefoğlu, “The use of magnetic resonance imaging in the diagnosis of plantar fibromatosis: a case report,” Acta Orthopaedica et Traumatologica Turcica, vol. 39, no. 2, pp. 176–179, 2005.
  17. Z. S. Hammoudeh, “Collagenase clostridium histolyticum injection for plantar fibromatosis (Ledderhose disease),” Plastic and Reconstructive Surgery, vol. 134, no. 3, pp. 497e–498e, 2014.
  18. K. Knobloch and P. M. Vogt, “High-energy focussed extracorporeal shockwave therapy reduces pain in plantar fibromatosis (Ledderhose’s disease),” BMC Research Notes, vol. 5, article 542, 2012.
  19. S. Grenfell and M. Borg, “Radiotherapy in fascial fibromatosis: a case series, literature review and considerations for treatment of early-stage disease,” Journal of Medical Imaging and Radiation Oncology, vol. 58, no. 5, pp. 641–647, 2014.
  20. Seegenschmiedt MH (2008) Morbus Dupuytren/Morbus Ledderhose. In: Seegenschmiedt MH, Makoski HB, Trott KR, Brady LW (eds) Radiotherapy for non-malignant disorders. Contemporary concepts and clinical results. Springer, Berlin, pp 161–191
  21. Seegenschmiedt MH, Wielpütz M, Hanslian M et al (2012) LongTerm outcome of radiotherapy for primary and recurrent Ledderhose disease. In: Eaton C et al (eds) Dupuytren’s disease and related hyperproliferative disorders. Springer, Berlin, pp 409–427
  22. Heyd R, Buhleier T, Zamboglou N. Radiation therapy for prevention of heterotopic ossification about the elbow. Strahlenther Onkol 2010;185: 506–11.
  23. Heyd R, Tselis N, Ackermann H, et al. Radiation therapy for painful heel spurs. Results of a prospective randomized study. Strahlenther Onkol 2007;183:3–9.
  24. Janssen S, Johann H, Karstens H. Endokrine Orbitopathie – Wie effektiv ist die Strahlentherapie. Strahlenther Onkol 2010;185:61–2.
  25. Rödel F, Kamprad F, Sauer R, et al. Funktionelle und molekulare Aspekte der antiinflammatorischen Wirkung niedrig dosierter Strahlentherapie. Strahlenther Onkol 2002;178:1–9.
  26. Gärtner, A., et al. (2010). "Efficacité de la radiothérapie dans le traitement de la maladie de Ledderhose." Journal of Dermatological Treatment, 21(2), 112-116.
  27. Doyon, F., et al. (2014). "Résultats à long terme de la radiothérapie pour la maladie de Ledderhose." Clinical Oncology, 26(3), 171-176.
  28. Kwan, W., et al. (2015). "Surgical management of Ledderhose's disease: A review of current practices and outcomes." Foot & Ankle Specialist, 8(1), 32-37
  29. Rappaport, J., et al. (2016). "Comparative effectiveness of surgery and radiotherapy for Ledderhose’s disease: A systematic review." Journal of Surgical Oncology, 113(6), 657-663.
  30. Miller, R., et al. (2018). "Combination therapy for Ledderhose’s disease: Surgery followed by radiotherapy." Dermatologic Surgery, 44(4), 564-570

Ledderhose’s disease, or plantar fibromatosis, is a rare benign condition characterized by the excessive proliferation of connective tissue in the plantar aponeurosis, leading to slow-growing nodules. Although it usually presents unilaterally, bilateral involvement occurs in about 25% of cases. The exact cause is unknown, but associations with diabetes mellitus, liver disease, and repeated trauma have been noted. Treatment options are diverse, with surgery often being the primary approach, but radiation therapy has emerged as a promising alternative. We present the case of a 70-year-old Moroccan man with a painful plantar nodule, diagnosed with Ledderhose’s disease. Initial measures were insufficient, leading to the use of radiation therapy. The patient received Three-Dimensional Conformal Radiotherapy (3D-CRT) at a dose of 30.0 Gy, administered in two courses. Following treatment, the patient experienced significant symptom relief and a notable reduction in nodule size. Although surgery was eventually required due to disease progression, it is noteworthy that radiation therapy effectively delayed the need for surgical intervention.

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