Ever heard of Dupuytren’s contracture of the foot? Nah, contracture of the hand is more popular but abnormal foot flexion is seldom discussed. What it is and what actions should we take to treat, or possibly, to prevent it?
Dupuytren’s contracture of the foot is known as Ledderhose’s disease (LD), plantar fibromas or Morbus ledderhose. Like the hand disease, it is a type of fibromatosis – scar tissues developing inside, usually under the skin. Causes are still unknown but it is closely related with autoimmune diseases. Our body’s immune system destroys our own cells and forms scar tissues and accumulates excess collagen. What a weird yet hideous way of betrayal inside our body!
As exact causes are still unknown, risk factors are identified for precautions, early detection, and treatment. A person with family history of both Dupuytren’s curvature of the foot and the hand may incur the disease, much worse, when he is a Caucasian male with over 70 years of age. A person with other health problems such as diabetes mellitus, epilepsy, liver disease, and thyroid problems poses higher threat of acquiring it. Smoking and alcohol use can stimulate cell mutation – leading to an abnormal immune response – thus, both lifestyle-related factors have been included. Foot trauma and overuse of the feet may also place you at risk, as well as punctures – wounds or tears can cause fibromas or scar tissues.
What happens with Ledderhose’s disease? Scar tissues, as above, also called plantar fibromatosis grow on the plantar surface or the sole of the foot. These are firm masses that grow slowly along the plantar fascia- which runs from the heel to the toes on the bottom of the foot- containing excess collagen or fibrotic tissue. At earlier stages, fibromas are small and do not impact foot’s ability. As they grow bigger at your sole, flexing your foot or bending the toes becomes more difficult and walking becomes painful. Early symptom includes a painful and noticeable lump in the arch, firm to touch and grows over time. Multiple fibromas may develop or they can merge to form a unified lump! As they grow in size, wearing shoes or walking barefoot might be very painful.
Dupuytren’s contracture of the foot is diagnosed by excising a part of the fibroma. Most of the time, the disease can be confirmed. But to visualize this, imaging studies are done such as MRI. MRI results shall help the doctor to determine shape, size and depth of the fibroma. In most cases, it even reaches the aponeurosis – the flat, fibrous sheet of connective tissue that attaches muscle to the bone. A thorough medical history shall also be taken to identify predisposing and precipitating factors leading to the disease.
Once diagnosed, treatment shall proceed based on the size and location of the fibroma and the pain it causes. Small fibromas causing minimal pain shall include treatments aimed to alleviate direct pressure on it. This is done through padding, functional foot orthotics, heel lifts, night splints or arch support. Reduction of pressure does not only minimize pain but shows to shrink the lump. Verapamil gel, a calcium channel blocker, usually used for cardiac problems, is applied to the mass twice daily to ‘constrict’ the fibroma.
For larger fibromas that inflict greater pain, two invasive treatment options are available. Cortisone injections stall the progression of the disease temporarily but may also induce inflammation. Surgery can also be done but with more accuracy and care since nerves, tendons, and muscles are located in the foot.
Now that you have rediscovered and redefined Dupuytren’s curvature of the foot or Ledderhose’s disease, you might think about your chances of acquiring it and ways of preventing it. Remember, prevention by being aware and living a healthier lifestyle is still the best deal than starting a cure!