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Suspect Ledderhose
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01/22/18 19:22
gorix 
01/22/18 19:22
gorix 
Suspect Ledderhose

Hello,

I have been reading this forum for the past few days... I have a firm, hard and mostly painless nodule under my foot. I don't have a diagnosis of Ledderhose so far but I really have no idea what else it could be.

No family history, male, 32 yo, nothing in my hands.

I have been sent for an ultrasound on my foot by my GP, who even without idenitfying it said that it should be excised.

The nodule is 0,8cm in diameter... how to know if it's Ledderhose for sure?Any advice?

01/22/18 21:54
spanishbuddha 

Administrator

01/22/18 21:54
spanishbuddha 

Administrator

Re: Suspect Ledderhose

gorix:
Hello,

I have been reading this forum for the past few days... I have a firm, hard and mostly painless nodule under my foot. I don't have a diagnosis of Ledderhose so far but I really have no idea what else it could be.

No family history, male, 32 yo, nothing in my hands.

I have been sent for an ultrasound on my foot by my GP, who even without idenitfying it said that it should be excised.

The nodule is 0,8cm in diameter... how to know if it's Ledderhose for sure?Any advice?
Hi gorix and welcome to our forum.

There can be various reasons for lumps in the feet, and it will take an experienced Dr or podiatrist to help with the diagnosis. Since it is one aspect of fibrosis that can exhibit other symptoms it may be that an overall health review looking at other risk factors might lean to this lump being an LD nodule.

LD nodules typically attach to the plantar, and there may be thickening of the plantar in lines from heel to toe.

My inclination at first would be, since it is painless, to leave it alone, and monitor it for changes or other symptoms that might go along with LD. But I am not a Dr. If LD is suspected and it does start playing up, increasing size of nodules that cause pain and affect mobility, then RT is your best option.

One of the best resources for LD is Gary’s blog, there is a patient forum, lots of useful info, including a FAQ. Have a look there too http://ledderhose.blogspot.co.uk

Best wishes

01/22/18 22:15
gorix 
01/22/18 22:15
gorix 
Re: Suspect Ledderhose

spanishbuddha:
gorix:
Hello,

I have been reading this forum for the past few days... I have a firm, hard and mostly painless nodule under my foot. I don't have a diagnosis of Ledderhose so far but I really have no idea what else it could be.

No family history, male, 32 yo, nothing in my hands.

I have been sent for an ultrasound on my foot by my GP, who even without idenitfying it said that it should be excised.

The nodule is 0,8cm in diameter... how to know if it's Ledderhose for sure?Any advice?
Hi gorix and welcome to our forum.

There can be various reasons for lumps in the feet, and it will take an experienced Dr or podiatrist to help with the diagnosis. Since it is one aspect of fibrosis that can exhibit other symptoms it may be that an overall health review looking at other risk factors might lean to this lump being an LD nodule.

LD nodules typically attach to the plantar, and there may be thickening of the plantar in lines from heel to toe.

My inclination at first would be, since it is painless, to leave it alone, and monitor it for changes or other symptoms that might go along with LD. But I am not a Dr. If LD is suspected and it does start playing up, increasing size of nodules that cause pain and affect mobility, then RT is your best option.

One of the best resources for LD is Gary’s blog, there is a patient forum, lots of useful info, including a FAQ. Have a look there too http://ledderhose.blogspot.co.uk

Best wishes

Hello Spanishbudda!

Thanks for your reply.


At first I thought I was too young for Lederhorse/Dupuytren... but then I found the blog you linked :p


I already read your story in Germany concerning RT... and 1 thing did strike me. You self-diagnosed a lump as LD but Prof. S. there said it was a ganglyon cyst. Am I correct? Was it on your sole? I wonder because I already read the literature and ganglyon cysts never seem to appear on the soles.

Also, wouldn't be better to be aggressive now instead of waiting for more lumps and pain to develop?

I already googled a lot and I am pretty sure that in my country there isn't any RT available for Lederhorse (unless maybe if I contact Prof. S. and he knows someone here, but I am not too confident about it.)

I hope ultrasounds will help with the diagnosis anyway here is attached a pic of the lump.

https://i.imgur.com/OIAR0NZ.jpg

Edited 01/22/18 22:17

01/22/18 23:17
spanishbuddha 

Administrator

01/22/18 23:17
spanishbuddha 

Administrator

Re: Suspect Ledderhose

Hi again gorix

Ganglions usually occur adjacent to a joint or tendon sheath. I had one in the palm on the MCP also on the wrist on a tendon, also dorsal side on the MCP. I never heard of one on the sole of the foot in my the arch.

I’m not sure what to say about your photo, doesn’t look atypical LD to me, but that counts for nothing. Does it feel firm, fibrous, more of it inside, also attached to the plantar? This is why we need an experienced Dr or podiatrist, but they may be hard to come by - with the experience of LD. The ultrasound may help determine its extent and relation to the plantar.

Early treatment of RT can be good, but usually with LD and DD we can wait and see if there are no obvious rapid developing changes, since it is mostly a slow developing condition. RT is pretty much a one off treatment (with some exceptions), so you want to take that one shot when the disease is active and new nodules occurring or existing ones are progressing.

A couple of guys on here have lived with LD for years, and despite lumps enjoy an active life. I hope you have found their posts. Gary was troubled at quite a young age with rapid progression and RT was timely and effective for him.

Best wishes SB

01/22/18 23:48
gorix 
01/22/18 23:48
gorix 
Re: Suspect Ledderhose

I do not know if "wait and see" is the best approach.
Others have been lucky (thanks for this discussion board!) but, correct me if I am wrong, once (if) the disease progresses then it is much harder to treat (gary had lumps at 13 yo in his feet, and then started to progress to be symptomatic 10 years later).

I thought that if you RT the area then chances of getting new lumps decrease? I did not know you have to wait for it to be "active".

Anyway, I am pretty unsure on the course of actions. I will be booking with a podologist/orthopedist after the ultrasounds for sure, but I said RT is not an option here anyway.

Btw this paper says Collagenase Clostridium histolyticum injections do not work for Ledderhorse, just wanted to share it...

https://www.ncbi.nlm.nih.gov/pubmed/25158740


P.S the lump feels ultra-firm and attached to the plantar.

Edited 01/22/18 23:51

01/23/18 08:49
spanishbuddha 

Administrator

01/23/18 08:49
spanishbuddha 

Administrator

Re: Suspect Ledderhose

RT is not a preventative. It acts by stopping progress during a specific phase of the disease and on conditions at the time. But even after RT new disease can occur with new nodules, and in the hand cords. Thankfully for most the slow course of the disease means RT will provide relief for many years, maybe a lifetime. This is why the timing of RT is important.

01/23/18 08:58
wach 

Administrator

01/23/18 08:58
wach 

Administrator

Collagenase for Ledderhose

Below paper just describes a single case where it did not work. That's not enough to draw a general conclusion on the effectiveness of collagenase for Ledderhose but you might be right nevertheless. A few more cases were reported when we did our patient survey in 2015 but they did not show good results either. Because it was less than 10 reports the outcome was not considered reliable and is therefore omitted on https://www.dupuytren-online.info/patient_survey.html. There is not much promotion for collagenase for Ledderhose and I am pretty sure it would be advertized if it really worked well.

Wolfgang

gorix:
.... Btw this paper says Collagenase Clostridium histolyticum injections do not work for Ledderhose, just wanted to share it...

https://www.ncbi.nlm.nih.gov/pubmed/25158740
...


Edited 01/23/18 09:00

01/26/18 03:07
eddavisdpm 
01/26/18 03:07
eddavisdpm 
Re: Suspect Ledderhose

Specificity is the key to effective treatment. Ledderhose disease is caused by a local defect in the tissue repair mechanism in which there is a failure to modulate scar tissue formation. The body utilizes fibrinolytic enzymes to induce the process of “breaking down” scar tissue or fibrosis.
Such enzymes can be introduced into the lesions by injection: http://www.ledderhosedisease.com/

01/28/18 18:43
gorix 
01/28/18 18:43
gorix 
Re: Suspect Ledderhose

eddavisdpm:
Specificity is the key to effective treatment. Ledderhose disease is caused by a local defect in the tissue repair mechanism in which there is a failure to modulate scar tissue formation. The body utilizes fibrinolytic enzymes to induce the process of “breaking down” scar tissue or fibrosis.
Such enzymes can be introduced into the lesions by injection: http://www.ledderhosedisease.com/

Hello Dr. Davis,

Are you aware of anyone doing what you do in Europe?

02/07/18 23:11
gorix 
02/07/18 23:11
gorix 
Re: Suspect Ledderhose

So hmm I did an Ultrasound and the nodule is above the fascia, in continuity with it, but above it.
So says the radiologist in the report (I confess I did try to compare the ultrasound images with confirmed cases of Ledderhose on the internet but until I can learn what is the fascia in the aforementioned images I am giving up).

I guess this should be an exclusion for Ledderhose, am I right?

Edited 02/07/18 23:13

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