My Plantar Fibroma / Ledderhose TImeline

Below I have put a timeline of how things have gone for me so far. There maybe typos and some of the dates maybe slightly off but I have tried to be accurate. 

Some pain today with my Ledderhose

As anyone who read here often will know my foot does not always hurt too much and I like to be able to do things for myself and indeed for my partner so I am perhaps not as much off of my feet as I should be.  I have however now got orthotics and I am at the stage where I have been wearing these all day which is pretty good and only slightly quicker than the doctor ordered so I don't think I have been too naughty.

I don't know if it is because the doctor poked it yesterday but today I have been in quite a bit of pain. To be honest I don't think that I can blame the doctor from yesterday as unlike last time he was very gentle and barely touched the lump let alone put any pressure on it (again shows that he knew what he was dealing with more than the other guy did). I think that the pain today is due to one of two things.

1) I have been on my feet more: Being on my feet more does mean more pain and today I was up and about a lot and that often means more pain but this hasn't been too much of an issue in the last few days.

2) It is just one of those days: The specialist also said that I just have to grin and take the pain as until it gets to the point where I really cannot walk they will not operate on ledderhose. This also means that I will have some days where it is painful, I mean I do have a disease after all so what should I expect.

I am hoping that on a day to day basis I don't have too many days like today, even once a month would be annoying but I think that it is something that I have got go try and get used to and the problem is knowing when I can push myself, what are the days when I can stay on my feet? What are the days when I need to sit down as much as possible? I guess that maybe as I become used to the Orthotics and with time I might be able to start to notice the signs of a troublesome day earlier rather than later an so will be able to make provisions and try to sit on my bum as much as my job will allow me.

The good thing is that my wedding and honeymoon are coming up and this not only is a great thing for the obvious reasons but also because it means that I should be able to sit a lot. To anyone out there that has ledderhose from what I have seen on the net and from what I have been told by the specialists you want to consider surgery as your last option only and they mean once you cannot walk. Just think about how much weight and how much pressure goes through your feet and your toes not just in a day but with every step and if you start messing about with that and messing about with the nerves then that is asking for trouble and in all likelihood if you are currently capable of walking then it is going to be more trouble than you are currently in. Of course I am not a doctor and you need to listen to what they say to you and not what I am saying as I am only 1 patient and not qualified so what I am saying is these are just my ramblings.

I have had experience with both orthotics and steroid injections and I am trying to build up a collection of details on different treatments but I will now be travelling outside of my experience with the disease so will be asking upon others for information where I can and I am going to try to make my next one of those kind of posts about surgery.

Steroid injections for the treatment of Plantar Fibromas

Steroid injections for the treatment of Plantar Fibromas / Plantar Fibromatosis / Ledderhose Disease:

So my first blog posts on the kind of treatments that are available comes in the form of the steroid injection. The idea here is that the injection will help reduce any swelling and hopefully will be able to decrease any pain to a more tolerable level. Note that I am not a doctor or a specialist and that everything on here is just my experience with the disease and some information from on-line resources and that you should trust what your doctor tells you. I am not responsible for what you chose to do so please don't make your choice based on what you see here and blame me.    

How and why do steroid injections help a plantar fibroma / ledderhose disease?: 

Steroids such as cortisone are released into the body from the adrenal gland after periods of stress. Their effect is normally short lived and can be weak due to delivery through the blood stream. The actual role of steroids in the body are not as specific as their use here but they do aid the reduction of inflammation (1). Their role in the healing process that they are trying to get with plantar fibroma's, is at least in my understanding to try and reduce inflammation that is being caused by the presence of the lump. It has also been shown that steroids added to cultured cells from Dupuytrens patients have increased levels of apoptosis, for those without a science background this is the process of programmed cell death and means that the addition of the steroids is targeting the abnormal cells and causing them to chose to die (2). 

Results?: 

I have tried to access research articles that cover this but have had no luck so I am restricted a bit in what I can say. For what happened with me see the end bit of this post. The only other account that I have is from someone on the Plantar Fibroma Support forum  (3). She had a very difference experience to me. She found that the steroid injection made the lump worse and was not at all helpful. I guess that the usefulness of these injections comes down to the stage, size and type of lump and the only way to know it works is to try. 

Side Effects: 

Well as you heard from the above case of a plantar fibroma being injected with a steroid it can make it more aggressive and do nothing useful at all. I think a fairly common problem is the one that I had (see below). I was fine when I had the injection but when the local wore off I was in agony and it felt like the bottom of my foot was covered in bruises and it was really unpleasant for 24 hours or so but gradually got better. As far as I am aware there are no serious side effects. Side effects are particularly worrisome in Ledderhose as the injection can cause loss of fat cells which will mean a lack of padding in the feet and potentially increase pain (4). 

My Experience: 

I had a steroid injection into my Plantar Fibroma in July(ish) 2010 and it was the second form of treatment attempted by the specialists after initially sending me for physio which was a know go from the start. I am not sure how this procedure it performed elsewhere in the world but in my case it was performed with the use of ultrasound to ensure that the steroid was delivered to the correct site and it was done under a local to ensure that I was not in too much pain. 

The process started with them having to find the lump under the ultrasound and this only took a minute and I was quoted as having one on the larger side. Next I was given the local to the surrounding area, this was quite painful and although it hurt it was not as bad as some of the reports I have read on-line and I guess this is because they were having the injection without the local but that is just a guess. I was then fine for the next few hours but then the pain became unbearable and I was hardly able to walk at all, this lasted about 24 hours and then gradually dissipated. I then felt an improvement in the lump as there was both a decrease in size and pain which lasted a couple of months before things returned. 

This picture is actually from much later when I was having radiotherapy but it shows nicely the area in which the steroid injection was applied - picture added 05/06/2012.

References: 

(1) Macmillan - http://www.macmillan.org.uk/Cancerinformation/Cancertreatment/Treatmenttypes/Supportivetherapies/Steroids.aspx accessed 20/01/2012: 

(2) 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

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

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

Blog is posted in association with Plantar Fibroma Forum