Ledderhose disease

What is Ledderhose disease?

Ledderhose disease (also called plantar fibromatosis) is a non-cancerous condition that affects the band of tissue along the bottom of the foot, known as the plantar fascia. It causes firm, slow-growing lumps (nodules) to form in the arch of the foot. These nodules may stay the same size for years, or they can gradually grow, sometimes leading to discomfort or difficulty standing or walking.

Common features of Ledderhose disease

Although Ledderhose disease is benign, it can cause symptoms that gradually worsen over time, especially if the nodules grow or become painful. Common signs and symptoms include:

• Firm lumps in the inner or middle section of the arch of the foot

• Pain when walking or standing

• A feeling of tightness in the foot or changes to the way you walk

• Trouble finding comfortable footwear

• Difficulty participating in sport, exercise, or daily activities

Causes of Ledderhose disease

Ledderhose disease develops when certain cells in the foot, called fibroblasts, become overactive within the plantar fascia, the thick band of tissue along the bottom of the foot. This overactivity leads to:

• Too many fibroblasts being produced

• A build-up of collagen (the main structural protein in tissue)

• Local thickening and the formation of firm nodules

You may be more likely to develop Ledderhose disease if you are male, middle-aged, or have a family history of the condition. It is also more common in people who have Dupuytren’s disease (in the hands) or Peyronie’s disease (in the penis), or who place ongoing mechanical stress on their feet.

The condition can affect one or both feet.

Treatment for Ledderhose disease

Radiotherapy is a safe and evidence-based, non-invasive treatment used in the early stages of Ledderhose disease. It can help reduce pain, slow or stop the growth of nodules, and prevent future problems with movement or function.

The treatment uses very small, carefully targeted doses of radiation to calm the overactive cells (fibroblasts) in the plantar fascia. By doing so, it helps control the tissue changes that cause nodules to form and harden.

How radiotherapy works

Radiotherapy works best during the active phase of Ledderhose disease, when the nodules are still developing. Treatment is given in small, carefully controlled doses, usually a total of 24–30 Gy, delivered in two short courses of 5 sessions (3 Gy each), spaced about 6–12 weeks apart.

The goal of treatment is to:

• Slow down the overactive fibroblast cells

• Reduce the tissue changes that cause nodules to grow

• Help shrink or stabilise existing nodules

• Relieve discomfort and prevent the condition from getting worse

Because Ledderhose disease affects tissue close to the surface of the foot, radiation can be safely directed to the affected area using specialised electron or superficial X-ray techniques, with minimal exposure to surrounding tissue.

What the evidence shows

Research from multiple clinical studies has shown that radiotherapy can be highly effective for Ledderhose disease. It can:

• Slow or stop the growth of nodules in many patients

• Reduce pain and tenderness when walking or standing

• Help shrink or stabilise existing nodules

• Lower the chance of needing surgery

• Provide long-lasting relief from symptoms over several years

Treatment works best in the early stages of the condition, when symptoms first appear. In more advanced cases, LDRT can still ease pain and discomfort, though larger or more established nodules are less likely to shrink.

Who might benefit

Radiotherapy may be suitable for people who:

• Have early-stage or progressive nodules

• Have pain, pressure sensitivity, or difficulty with footwear

• Would like to avoid or delay surgery

• Have nodules in several areas or in both feet

• Have recurrence after prior treatments

• Have co-existing fibroproliferative conditions (e.g., Dupuytren’s disease) where there is a higher recurrence risk

Surgery may be an option for larger nodules, though recurrence is common. Radiotherapy provides a non-invasive alternative when used earlier in the course of the disease.

What to expect

1. Consultation and planning

You will meet with a Radiation Oncologist to assess the stage of disease, nodule characteristics, current symptoms, and your goals for treatment. If treatment is appropriate, a customised plan is created to cover the active disease while protecting surrounding tissues.

2. Treatment delivery

• Outpatient treatment over 5 sessions, with a second short course 6–12 weeks later

• Delivered using superficial X-ray or electron beam therapy

• Completely painless

• Sessions take only a few minutes

A transparent template and shielding device are used to precisely shape the radiation field to the plantar nodules.

3. After treatment

You may resume normal activities immediately. Mild temporary skin dryness or redness may occur but typically resolves quickly.

Treatment benefits often emerge gradually over months as fibroblast activity settles and nodules soften.