Wednesday, 8 February 2012

Symptoms and risk factors of Ledderhose disease

My foot was not too bad today but it was far from great and far from what I would call acceptable level for daily pain but I can live with it. So on to the main part of the post today which is about....

Symptoms and Risk factors of Ledderhose Disease:  

The main symptom is of course the appearance of nodules in the medial and central part of the tendon in the base of the foot which is called the plantar fascia. The nodules or lumps are normally firm to touch and slowly progress in size. Over time the cords of the plantar fascia can thicken and it can lead to a restriction of toe movement. Normally once the nodule reaches a large enough size walking will become painful and this will also be caused by applying any pressure to the lump.

Official Symptoms:

My Symptoms:
I have referred to official things above but thought I would continue by saying what happened to me. So to start with when I was younger I noticed that I had a small and non-painful lump in the arch of my left foot and so left it alone. For many people it will stay like this and although they do have a plantar fibroma it remains asymptomatic and so it is best to just leave it alone as it will do more harm than good to poke the beast. [1]

Then a few years later I started showing what I would call signs of Ledderhose disease. So the lump started to increase in size I guess you could say that it went into a proliferative phase and the size of it that I could feel went from smaller than a pea to probably about an inch long in a couple of months. The increase in size was associated with an increase in pain and a trip to the doctor. From the fact that the pain was increasing with weight bearing and there was the lump his initial thoughts were that it was a Plantar Fibroma, he also thought that I may have plantar fasciitis due the fact that I had a lack of flexibility but also pain upon standing that wasn’t as bad as the pain that built up. I have also noticed that the plantar fascia has thickened, this is particularly bad around the lump and is what I think has led to my final symptom which is restricted movement in my toes on my left foot. See here
   

Risk Factors:

Having one of the related diseases - This may seem obvious by if you have either Dupuyten's (DD) or any of the other related diseases this is a sign that in all likelihood you are more likely to be predisposed to getting Ledderhose (LD) and in fact the other risk factors are mostly the same for both diseases. [1] It is thought that as many as nearly 30% of people with LD have DD whilst it may be as little as 2% of those with DD that have LD (though higher estimates do go up to 20%). [1] I do not have any of the related diseases.

Family History - It has been suggested that LD and DD are both genetic and that if you have family members with it then you are more likely to have the genetics that give you an increased risk [1]. I have seen many cases on-line where people have said something like "I was worried I would get it because my Mum had it" and there was also this recent article - Real People Interview [2]. Personally I have asked round all my family and nobody can remember anyone with either of these diseases and if that is correct then it goes back 4 generations and through many different branches which suggests this was not a factor for me.

Beta Blockers: There have been links to an increased risk for those who have been on beta blockers [1].

There have also been links made in the past which are as yet unproven to:

  • alcoholism (I do not drink) 
  • Smoking (I do not smoke) 
  • Liver Disease (Fine as far as I am aware) 
  • Thyroid problems (same as above)
  • Maybe men at higher risk (I am a man) 
So as you can see there have been links to lots of different thing but nothing concrete is really there though there is some genetics in play in many cases but whether this is a requirement or not is unknown. As you can also see I do not really seem to be at a high risk but here I am sitting with a lump in my foot. 

References: 
 [1] Charles Eaten et al, 2012, Dupuytren's Disease and Related Hyperproliferative Disorders, Berlin, Springer publishing group.
[2] British Dupurytren's Society - http://dupuytrens-society.org.uk/RealPeople.html