Sunday, 6 April 2014

Interview with a UK based Dupuytren's and Ledderhose patient

The following interview is with a Dupuytren's and Ledderhose patient from the UK. He has had surgery, more information can be found here. 
1) Do you have Ledderhose disease, Dupuytren’s disease or both?   
photo.JPGBoth. Dupuytren's of my left hand was diagnosed in 2004 at Addenbrooks Hospital, Cambridge. It was causing a lot of pain as it bent up and nodule appeared on the palmar fascia. I didn't really know what it was at first. No surgery was recommended, and it has only slightly deteriorated over the last 10 years. The pain is intermittent, but bad when I catch it on something! I have very limited mobility in my little finger and can’t straighten it. The nodule is clearly visible.
My plantar fibromatosis was diagnosed in early 2009 by Mr Phillip Milsom in Colchester, Essex. He operated on my left foot (the worst of my two feet) in June 2009.

2) Do you have a family history of the disease or have any increased risk from other risk factors such as excessive alcohol consumption, smoking, diabetes etc?
My father had both hands operated on for his Dupytren's at different times; it reduced pain but increased mobility was very short lived. At a family party, I also noticed my great aunt had it in one hand. I don’t excessively consume alcohol, nor smoke. My paternal grandmother was diabetic.
3) How long had you had Ledderhose before considering Surgery? And what other treatments had you received / were you offered by medical professionals?
My GP nearly tried to lance the nodules on my foot! He believed it to be a ganglion cyst, however, thankfully he referred me to the specialist Mr Milsom. This was in early 2009 when I had chronic pain from my foot and it was starting to affect my work and sporting activities. Despite the the risks associated with surgery, he recommended this as the best plan of action. It was unusual to have Ledderhose at my age, I was 26 at the time.
4) Before Surgery were you made aware of the rate of reappearance after traditional surgery and did this concern you?
Yes, but I needed to do something. I am a teacher and I was having to take my shoes off and teach barefoot as the pain was so great. After playing hockey on a Saturday, I had to rest for most of Sunday.
I was warned that that success rate was variable and that they could easily come back, with more or less pain. It was obviously a major concern, but I was willing to try it.
5) Were you at the stage where you couldn't walk before you had surgery / what sort of pain were you in?
Obviously I was not totally incapacitated but the pain was regular and at times severe. When I woke up in the morning, it was often bad. I had a burning sensation or a dull ache. Walking on uneven surfaces was particularly difficult, the beach was the worst! I had to stop wearing several pairs of shoes as they were just impossible to wear without huge amounts of pain.
6) What kind of surgery did you have and how long did it take?  
34255_683679309390_4913749_n.jpgA large part of the plantar fascia was removed including the section where the nodules were. This operation was carried out by the consultant himself at Colchester General Hospital, Essex.
I was under local anaesthetic, I had several injections in my foot before being taken into surgery. My foot was elevated and a screen placed across my torso so I couldn't see down to my feet. It was a very odd sensation, it felt like someone was drawing on the base of my foot with a biro pen.
The operation lasted about an hour. After which I was allowed to go home.

7) How did the treatment go? How long did the treatment take and what was recovery time like?
29922_680035461690_6393512_n.jpgThe operation was a success. However the recovery time was long. I had the operation on the 1st June and I was on the sofa for June, July and most of August. I returned to work on the 1st September.
Friends and family were good to me and took me out, however I can see how depression can kick in. I was taking a large dose of painkillers to begin with, but they left me constipated, and so I had to reduce those. I found it impossible to get comfortable and I slept a lot.



8) How long ago was the Surgery treatment? Have the lumps grown back? If yes how long did they take to grow back and are they worse now?
photo.JPG

The surgery was 5 years ago (2009), and the nodules reappeared about 2 years after surgery. I actually now have more and bigger nodules, however they are less painful than before. I regard that as a partial success.
However, as I am only 30 now, I do worry that the pain will return to the level it was previously. I still get the burning pain and the dull aches, and after sport it can be very painful. I elevate it when this occurs.

9) Would you say that the surgery was worth it? And would you recommend it to people that have Ledderhose? Would you consider having it again?
For pain relief, yes it was certainly a success. However I do have reservations about it being labelled a cure. Perhaps it is for some people, but obviously mine are now bigger than they were previously!
Since discovering this blog, I am in the process of considering my next step. I am looking at alternative treatments as I do worry that this is only going to get worse. I love to play hockey, and to run; I have managed two half marathons with my Ledderhose.  
10) What would you say your standard of walking is at the current time and do you think this would be different had you chosen not to have Surgery?
I would definitely say things are better, and perhaps its current state is the best it ever will be. I think I have come to the realisation that this may be something I need to cope with for the remainder of my life. There are worse discomforts in life, and it is certainly not debilitating. It is an inconvenience though, and I do very much worry that it may get worse at some point in the future.
11)  What treatments have you tried since surgery?
None to date.
12)  What treatment options are you considering now?

I plan to visit my GP in the area where I now live and start the process from scratch to see what is offer in my new area (Upminster, Essex) on the NHS. However I realise that I may need to seek private treatment either here or in the US. If something closer to a cure is available, the cost will be insignificant compared to the freedom it would offer.
That is the end of my interview with Andy Lewis. He has given some great answers and it is interesting to hear that at the moment his surgery is sort of successful as he isn't suffering from the same degree of pain as he was before. It will be interesting to know what treatment he is offered and what treatment option he goes for. There are certainly still some available whether it be Radiotherapy, Cryosurgery or an enzyme injection.

Tuesday, 1 April 2014

Interview with RT and Hyaluronidase patient from USA

The following is an interview with a patient that has recently had Hyaluronidase injections with Dr Davis, see my interview with him here. 

1) Do you have Ledderhose disease, Dupuytren’s disease or both?

I have both

2) Do you have a family history of the disease or have any increased risk from other risk factors such as excessive alcohol consumption, smoking, diabetes etc.?

My father possibly has Dupuytren's, not officially diagnosed and not active. I do not drink, smoke, have diabetes or any other risk factors other than partial European heritage. 

3) How long had you had Ledderhose before considering each of your treatments?

The Dupuytren's started in my 20's (I think it started after carrying heavy buckets), I developed nodules which remained inactive for 20 or so years. Next I had frozen shoulder (which is also possibly linked) in one shoulder then the other when I was about 40 or so. My dup began to be active 5-8 years after that. After consulting orthopedic doctors who recommended doing nothing until the contraction was really advanced I researched and decided to have NA done. Which I did and was pleased with the results but wasn't splinting at night, so after about a 1-2 year time my hands (right in particular) to begin contracting again. The next procedure was not due to the advancement of the disease but because I got a sliver in the largest nodule on my right hand which got infected. I had to have surgery in order to stop the infection however the surgeon did not remove the Dupuytren tissue that went into my fingers because of the risk of the infection spreading into my fingers. So I had a partial removal of the diseased tissue, this was in Jan 2013. Since then I have 2 new nodules in other parts of that hand and the one up against my ring finger is enlarging. My left hand is contracting, but fairly slowly as I began to splint at night.

My Ledderhose started in 2011 when I began to notice a "thickening sensation" in the balls of my feet when I got up in the morning. And not wanted to deal with it I ignored it, ha that worked well. Anyway after a few months I began researching and decided to have RA in Germany which I did in Sept and Dec. Prof S increased the size of my target area because I did have something in the ball of my right foot which he thought could be a fibroma. I didn't have my hands radiated the first trip because I didn't think they were active at the time, but the second trip they were itching so I did have one treatment on my hands as well, but didn't go back for the second because of the advanced state of my hands the odds were not in my favour for much effect. My feet began to really hurt during the last 2 days of my second treatment. I began to not be able to walk much at all, which continued after getting home until I had the Hyaluronidase injection.

4) What sort of pain were you in before you had each of the treatments? 

I was never in much pain with Dupuytren's--other than a feeling of discomfort that my hand was out of alignment, just an occasional aching or rarely a sharp pain. Mostly itching when it is active. With my feet there was pain but not intense until after the 2nd round of radiation. Then my feet just hurt and I could only be on them for a few hours at a time and had to sit often. If I went shopping I used a wheelchair etc. and used it in my house just to relieve some of the pain. It got so bad that I wondered if it was more than just Ledderhose, especially because I do have some apparent fibromas in the balls of my feet which is not the norm.

5) I have not heard from a patient that has had the Hyaluronidase injections, please could you explain the procedure? 

I had an MRI before I decided to go to Dr. Davis so that I could try to assess if more was going on than the Ledderhose. But after I got to Dr. Davis' office he used a portable sonogram to check what was going on and he said it helped him to assess it better than the MRI because he could move my foot and watch to see how the nodules responded. He did not pressure me at all and almost didn't give me the hyaluronaidse because it just seemed my symptoms were so severe and different than other Ledderhose. My nodules never did get very big about the size of a large semi-squished grape. I opted for the injection and am so glad I did. The first time he spent quite a lot of time with me really examining my feet and then discussing orthotics and also a topical ointment. He then did a nerve block on my feet then a local anesthesia and then injected the Vitrase brand of Hyaluronaidse using the ultrasound to guide it exactly where he wanted it. The next day after the nerve block wore off it was almost like I had my "old" feet back. I was to go back in 3 weeks for the orthotics and also for another injection, which I did. This time I opted out of the nerve block (that was the most uncomfortable part to me) and the injection was not bad at all. The orthotics are to try to make me walk differently on the balls of my feet so the fibromas there will hopefully get some relief. I also just started using the topical because he is not comfortable injecting the areas in the balls of my feet because of the potential tissue damage there.

6) How did the Radiotherapy go? 

I think I answered this above. I really didn't notice any other side-effects except the pain after the 2nd treatment in my feet--no burning or redness or anything like that. The nodules in the arches of my feet stopped growing after this. Whether or not I had the all the other nodules in my feet at this time is questionable to me--I'm just not sure. My hands only had one treatment and they were already too far along to do much good.

7) How did the Hyaluronidase treatment go?  

I have no negative things to say about the Hyaluronidase treatment, the worst part as I stated above was the nerve block and having my feet asleep for the trip home and overnight. There was very little pain with the injections themselves and the results so far have been amazing --probably 80% better pain level than before.

8) How long ago was the Hyaluronidase treatment? 

My first injection was 4 weeks ago and the 2nd 1 week ago.

9) Would you say that the treatments have been worth it? And would you recommend any of them to people that have Ledderhose? 

I think these treatments are more than worth it. I cannot attest to the long-term results but I am thrilled thus far. I would have started with this without a doubt over RA. It has given me my walking life back , Hyaluronidase has been used for cosmetic procedures for years--If I have to do it again in 2-3 years I will, however that is not the norm according to Dr. Davis testimony he does not get patients who return and he has been doing this for over 20 years.

10) Do you have anything else you would like to say to Ledderhose patients?

I had given up and resigned myself to a wheelchair…this has given me hope, don't give up.

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This treatment appears to have very good results and I hope that continues for this patient and for any others that decide to have it. I would say that the time from the treat to now is clearly not enough time for the lumps to grow back.

From my interview with Dr Davis I know he claims to get very good results but given the lack of published medical data and the statement below recurrence is something that concerns me.

(Originally pointed out by Wolfgang on IDS forum)
For Dupuytren's contracture McCarthy wrote in 1992 "We reviewed ten hands in nine patients who had enzymatic fasciotomy for Dupuytren's contracture, with an average follow-up of 6.5 years. While all patients were initially satisfied with the results, the disease recurred quite rapidly to pre-operative levels in seven patients over the subsequent two to three years" http://www.ncbi.nlm.nih.gov/pubmed/1624874 

It will be interesting to see how things go in future years and to follow up with some patients that had this 5 or so years ago to see how they are doing now. 

The above patient is Penny on the IDS forum.

Friday, 28 March 2014

Update to Dr Davis Interview

Not that long ago now I did an interview with Dr Eddie Davis on the use of Hyaluronidase, this is an enzyme that specifically acts to reduce scar tissue in a similar fashion to collagenase. It appears that this has drawn the interest of many patients. I am already in discussions with one patient that has now had the the treatment and hopefully then will soon be providing answers to some interview questions. Another patient has seen the interview and decided they would like to know more, so they asked Dr Davis some questions and posted the results on the International Dupuytren's Society forum and have kindly allowed me to share them on here. 

Please see the interview here and scroll down to find the new questions and answers. It would be great if there was a published medical article on this treatment as it appears that the results are good for patients but many people, especially other medical professionals, would like to see some proof that the treatment works for the condition before the consider using it themselves. 

I do have some other Ledderhose news but I will wait for it to be more formalised before I consider posting another about it. There will also hopefully be a few more interviews on the way. 

Don't forget if you want to be interviews, point out a mistake or have a suggestion then please get in touch as I want to do all I can to make this site as useful as possible. 

Monday, 24 March 2014

Interview with patient who had minimally invasive surgery (Tenex)

1) Do you have Ledderhose disease, Dupuytren’s disease or both?   

Ledderhose only at this time.

2) Do you have a family history of the disease or have any increased risk from other risk factors such as excessive alcohol consumption, smoking, diabetes etc?

Possible Grandfather with Dupuytren's.  No other significant risk factor.  

3) How long had you had Ledderhose before considering Tenex? And what other treatments had you received / were you offered by medical professionals? 

I had the painful lump for about six months when I made the decision on Tenex.  I was offered surgery, but was told of the risk.  I did do shock-wave therapy which gave me some minor relief from the pain.  

4) Before Tenex were you made aware of the rate of reappearance after traditional surgery and did this concern you? 

Yes and while I won't totally rule out surgery, it will be a last resort.  

5) Were you at the stage where you couldn't walk before you had Tenex / what sort of pain were you in?

I can walk, but with significant pain.  I walk slowly and I must limit my walking and time that I stand on my feet.

6) Tenex is not that familiar to me, please could you explain the difference between it and regular surgery?

Tenex was originally called the FAST procedure and developed at the Mayo Clinic.  It is a focused aspiration of soft tissue.  No cuts are made.  A small needle goes into the nodule and it is removed by aspiration.

7) How did the treatment go? How long did the treatment take and what was recovery time like?

The procedure was very easy.  It took about 15 minutes total and I was able to walk out of the office and just stay off my foot for a day.  I was "supposed" to be that simple with no follow up necessary.  

8) How long ago was the Tenex treatment? Have the lumps grown back? If yes how long did they take to grow back and are they worse now? 

It has now been two months since the procedure.  It appeared to just be swelling right after the procedure, but now after 2 months, the lump is larger than before treatment.  I must give a disclaimer that the physician who treated me is insisting at this point it is a hematoma rather than a fibroma.  I am the first Ledderhose patient he has ever treated.  He did say it is possible that the hematoma is on top of the fibroma, but at this point I do not have a clear diagnosis.  Gary, I will update you by e-mail once I do and you have my permission to update this interview.

9) Would you say that the surgery was worth it? And would you recommend it to people that have Ledderhose? Would you consider having it again? 

At this point I would say it is an option, but it is not proving successful for me.  I will be pursuing other options once I can get a clear diagnosis from a physician.

10) What would you say your standard of walking is at the current time and do you think this would be different had you chosen not to have Tenex?

My standard of walking is worse since the procedure as the lump is larger and presses against any kind of shoe and even the floor when barefoot.  I was better off before the surgery and the lump was softer.

11)  What treatments have you tried since surgery?

Since it has only been two months, I have not tried anything other than ice/heat and massage.  Massage tends to annoy it and ice and/or heat have little effect.  The nodule does fluctuate in size as it always did, so some days are better than others. 

12)  What treatment options are you considering now?

Right now I am considering two options.  Either Hyaluronidase injections from the doctor you interviewed in Texas or Radiation Therapy.  They are very different procedures and I still have more research to do before making my decision.

More Information from patient:

Tenex is such a new procedure that the only information out there is from their website:  http://tenexhealth.com   The website lists the physicians that have been trained and are currently using the technology.  I called several doctors from the website and heard back from five of them that they had successfully aspirated fibromas.  I was treated by a doctor near where I live and I was his first fibroma patient.  He spoke to another physician that has successfully treated this condition and performed the procedure using that physician's protocol.  He did tell me that a fibroma is at the very top end of what they feel the Tenex device can handle as it is a small needle with a limited amount of power.  Thank you for all the work you do on your blog.  I have found it very helpful.  I will let you know how things go in the future and also what treatment I decide on next.  Best Wishes.

Follow up e-mail from patient

I had an ultra sound a few days ago and my doctor confirmed that the hematoma has healed and now he can clearly see the fibroma. It is also significantly larger than it was prior to Tenex. Feel free to update my interview. Because walking has now become difficult, I discussed RT and H. Injections with my doctor. He spoke with Dr. Davis in Texas and feels comfortable using his protocol. I've decided to go ahead with the injections. I would to glad to let you know how it goes. 

Friday, 21 March 2014

A patients perspective: A brief overview of all things Ledderhose

This condition, which for simplicities sake I will just call Ledderhose, is an often painful condition which presents as a lump or knot in the arch of the foot or feet. The purpose of this introduction is to try and make a concise overview of the significant amount of information I have learnt over the last 3 years. 

This information has come from books, the internet, and conversations with patients, conversations with doctors and conversations with scientists. I hope to cover a little bit about what the disease is, how it can present itself and how this can be very different patient to patient. I am going to look at the risk factors and the different treatment options and will try my best to offer an unbiased opinion on the treatment options. 

If you are new to the condition hopefully you will find this helpful, if you are familiar with the condition then perhaps you might still learn something. I hope to be able to tell it as a patient, first developing the condition (risk factors), seeking information (the basics of the condition), disease progression and then treatment followed by anything else I see fit. 


Much of the information I have taken from conversations on the related condition Dupuytren's, here I will basically treat the conditions as the same thing from a risk factors and science point of view, the treatment options are Ledderhose specific. 

Developing the condition

Ledderhose is not something you can catch from another person, well not like a cold, but it often will have genetic links. It is thought that Ledderhose requires several changes to a pathway as well as perhaps a triggering traumatic event. The genetic changes that are required can be inherited from your parents, this will greatly increase the odds of you developing the conditions. 

A family history is by no means required for this condition to develop and indeed a strong family history does not mean you will 100% develop the condition. See the family trees shown below: 


Figure 1: 
a) Family tree of a patient with no family history.             






b) Family Tree from a family with a lot of family history of Ledderhose and related conditions.








As you can see from the 1st family tree there is no genetic predisposition for the condition, there is no family history of the condition, this either means that there was no underlying genetic element in this patient or the individual patient likely developed many themselves. The 2nd family tree shows a strong family history of the condition, this likely meaning that they have many of the predisposing genetic elements in place from birth and are therefore highly susceptible to developing the condition. 

What does this genetic side mean? That those who have a genetic background are more likely to develop the condition. 

There are many other factors that have also been linked to the progression of this condition. Nothing has really been proven but it appears that doing things that give you a chance of having underlying health issues will likely results in an increase in your odds of developing Ledderhose.

Other factors that have been linked to these conditions includes over drinking. More specifically it seems to be linked to the possible liver damage that can come from over drinking. Diabetes is another proposed risk factor. The conditions have been linked to various insulin related pathways so it is not surprising that a defect in this pathway can increase the odds of developing these conditions. Another possible risk factor is smoking this causes underlying health issues and in many cases could be linked to excessive drinking.

The final risk factor that I shall mention is trauma. Trauma to the foot could be picked up on many ways e.g. I may have stepped on a stone when running and I have heard a child developing the condition after damaging their foot (personal communication). I shall not go into detail here but Ledderhose seems to share pathways and processes with the healing and scar process and it could be an over-activation of these pathways that ultimately causes the condition. So if you think you are at risk there is no harm in being careful with your feet. 

Disease Basics

So maybe the disease basics should have come first by personally I had no clue what this conditions was before I started developing it and therefore felt that its rightful place was after the factors that can increase your chances of developing the condition. 

Ledderhose lumps are basically a ball of cells that are growing too quickly, therefore they form a tumour. This is much the same process as cancer except they cannot spread so please do not confuse the 2, in fact see this post on why this condition is not cancer. The lumps that are formed are very hard, this is because the nodules that form are high in collagen. Collagen is a protein that is often found in repairing tissue and this is why the condition is thought to start with a trauma and develop as an overreaction to the repair that is necessary. 

Diagnosis and Progression

Diagnosis is normally initially achieved through palpation of the lump and will often then be confirmed with an ultra-sound or ultimately an MRI. It is not until an MRI is performed that the tissue can truly be differentiated between basic scar tissue and a fibroma [Personal Communication].

Disease progression is highly variable, not just in terms of the size of the lump(s) but also in terms of pain. As an example one patient could have a large lump and no pain, another patient a small lump but a lot of pain, the patient with the large lump could have only developed the lump in the last few months whilst the smaller lump may have taken years to develop. I for example had a gradual increase in pain over the course of a couple years until it reached the point where I could not walk. Despite me being unable to walk my lump was not that big. It is not possible to tell whether a lump will become painful or not and therefore it is not possible to guess what the best treatment option will be.

Treatments and considerations:

There are many different treatment options but there is no perfect treatment option. Below I am going to try and cover some of the more common treatment options and discuss the pros and cons:

Surgery:

Surgery has long been the go to treatment for Ledderhose patients. However surgery has also had the problem that it suffers from high recurrence rates. This means that for a lot of patients that have surgery the lumps with grow back. I have spoken to some patients who have had surgery work and are happy with the results many years after treatment. I have also spoken to patients who are unhappy with the results of surgery just months after they had the treatment. I have spoken to one person has had 20 plus surgeries and is still battling the condition. The success rates have increased with the use of greater margins or complete removal of the plantar fascia.

The Pros for surgery are that it is the standard treatment used and is readily accessible.

The cons are numerous. It is invasive, requires a long time off of the foot, it requires physiotherapy and the chances of the condition coming back are high.


Radiotherapy

Me getting Radiotherapy
Radiotherapy has emerged in the last 20 years as a real treatment option for many benign conditions including Dupuytren’s and Ledderhose. When performed correctly the success rate is in the region of 80% of patients seeing an improvement. I personally have had radiotherapy and for me it has worked really well, the process is 5 treatments on consecutive days followed by a repeat of that around 8 weeks later, each treatment takes 5-10 minutes. I went from using a walking stick and being in a lot of pain to being in less pain, then I could stop using the stick and then I started running and completed a 10km run. Overall I couldn’t be happier with how it went for me. I have heard of it not working for some patients and there are risks. Any radiotherapy, even the lose doses used in this treatment, will increase the risk of the patient developing cancer. I suffered from dry and itchy skin on my foot for several months which was irritating but E45 helped.   

The pros are the treatment has a good success rate and is not invasive and doesn't require time off of your feet.
The cons are that in the UK at least you will have to go private to get the treatment and the increased risk of cancer. Limited locations offer radiotherapy for Ledderhose and related conditions.

Other options:

On the NHS in the UK the final option provided is surgery, as mentioned you can get radiotherapy and there are other treatments that will get tried first or are just becoming available.

The first of these is steroid injections. In some cases it has been found that steroid injections can ease the pain and shrink the lumps that are caused by Ledderhose. These injections can be very painful and one specialist I spoke to advised against them because "There is no specific evidence that I am aware of that steroid injection helps or improves this condition" [Link]. There is no overwhelming evidence that it will help and it can cause problems with the tendon. I did have a steroid injection, it did hurt but it did seem to ease symptoms for around 6 months to a year.

The second option is very likely to just be a stop gap solution. This option is orthotics. Orthotics are shoe inserts that are supposed to help distribute weight around your foot and take weight off of the lump. They can help but will need changing if the lump is growing or your walking bio-mechanics are changing as the pain increases. I still use orthotics now, for me they are more of a corrective tool to try and help me walk normally now that the pain has gone.

The third option is just becoming available in the UK, cryotherapy / cryosurgery. This option involves freezing the area with a very cold needle, this numbs the pain indefinitely and has been shown to have good results. This treatment does not however have any publications proving it is a good and viable treatment option. There are also very few locations worldwide that offer this treatment for Ledderhose.

The fourth and final option is a gel called Verapamil. I am not aware of this being widely available in the UK but it is available in the USA. The gel is supposed to block a pathway required for nodule formation and this will stop growth and ideally cause the lump to shrink. I guess the best way to sum this treatment up is as a quick summary of most patient responses; 
"Verapamil may have helped, it may have stopped it from getting worse or have slowed it down but I am not sure". The gel seems to help some, in most it helps but not enough.  

I have not mentioned Xiapex, this is an enzyme injection. In theory it and similar injections can be used in the foot but this is currently mainly a Dupuytren's treatment. 

After treatment:

What happens after you have had treatment is highly variable not only from treatment to treatment but also from person to person. With surgery there will be time on crutches and a high chance of it coming back. With radiotherapy there will be dry skin and the increased risk of cancer. 

Something that all patients will have in common is the fear it will come back or indeed the fear it will spread. The hands and the feet are all potential targets as is the shoulder and other areas I would rather not talk about.  

Summary

I guess one of the biggest things is that the ultimate go to option still seems to be surgery, yet here is a quote I got from a UK surgeon about this condition: 

"Finally the text book, which is Surgery of the Foot and Ankle, is probably the most authoritative text we have on foot and ankle surgery and it quotes “attempted surgical resection is best avoided”."

This shows that the go to treatment option is one that is best avoided. I am not saying don't have surgery I just think that you should always discuss all the options with your doctor before having surgery for this condition as there is no guarantee it will help, in fact it can even make things worse. 

Now patients and professionals need to work together to improve patient care, to improve both professional and patient awareness of all the treatment options and make sure that everyone gets the treatment that gives them the best chance to heal.  

References

You might want to check out the following link: Plantar Fibroma - A real pain in the foot

For more information on different section and to see where I obtained the original information from please use the following links: 

Risk Factors:

Genetics

Dupuytren's Disease and Related Hyperproliferative disorders, Chapter 11 - The Genetic Basis of Dupuytren's: An introduction

Is Dupuytren's in your DNA?  - A blog post previously done by me

Diabetes: 

Elhadd et al, 2007, Plantar Fibromatosis and Dupuytren’s disease: an association to remember in patients with diabetes, Diabetic Medicine, 24, p1305:

Stradner et al, 1987, Dupuytren's contracture as a concomitant disease in diabetes mellitus, Wien Med Wochenschr, Vol 137, p89-92.  



Alcohol and smoking: 

Harrt and Hooper, Postgrad Med J 81:425-428 doi:10.1136/pgmj.2004.027425, http://pmj.bmj.com/content/81/957/425.long


Burge et al, 1997, also find the same results as the above paper in that alcohol is related to Dupuytren's and this is further backed up by (5) Bradlow et al 1986

Gudmundsson et al, 2001, Scand J Health care, vol 19.

An HS, SouthworthSR, JacksonWT, RussB. Cigarette smoking and Dupuytren's contracture of the hand. J Hand Surg Am. 1988Nov;13(6):872-4.

Treatments: 


Cryosurgery post by me with more links contained

Steroid injections: 

Steroid injection - a post by me 



Meek et al, 2002,The effect of steroids on Dupuytren's disease: role of programmed cell death, J Hand Surg Br. 2002 Jun;27(3):270-3.accessed 21//01/2012

Plantar Fibroma Support Forum - Post by peekaboo64 http://plantarfibroma.freeforums.org/injections-t9.html

Dupuytren Online, Steroid Injections - http://www.dupuytren-online.info/dupuytren_steroids.html accessed 21/01/2012

Othotics: 

Orthotics: a post by me


Radiotherapy: 

Personal experience and personal communication with Dr Shaffer and other medical professionals

Interview with Dr Richard Shaffer - He covers a lot of the basics and there is some good information.

Radiotherapy post by me

Book: Radiation Therapy for Early Stages of Morbus Ledderhose: Dupuytren’s Disease and related hyperproliferative disorders, chapter 50 – Long-Term Outcome of Radiotherapy for Primary and Recurrent Ledderhose Disease:

Surgery: 

Personal communication with multiple patients 

Surgery a post by me 

Dupuytren's Disease and Related Hyperproliferative Disorders: Principles, Research, and Clinical Perspectives -

Charles Eaton M. Heinrich Seegenschmiedt Ardeshir Bayat Giulio Gabbiani Paul Werker Wolfgang Wach