Gender bias and trauma in Ledderhose and Dupuytren's

The large patient survey we are conducting has already revealed many interesting facts. One of these facts is that it appears that although Dupuytren's is more common in men (as expected), Ledderhose however appears to have a higher prevalence in women.

In order to investigate this further I have done a shorter survey with a lot of help from 2 Facebook groups.

Hypothesis and Method: 

The apparent different gender bias of Ledderhose and Dupuytren's is caused by the different lifestyles of men and women. Men are more likely to have jobs that will cause repetitive strain on their hands whilst women are more likely to put strain on their feet by wearing high heels.

Therefore this survey was to see whether there were more markers for trauma in the hand in Dupuytren's patients and whether there was more signs of trauma in Ledderhose patients.

The survey can still be taken here.

Results:

Graph 1: Percentage of patient groups with or without hand issue

The results in graph one are separated out into Dupuytren's, Dual and Ledderhose patients and within in group it is separated into men and women and those with or without a hand issue (trauma or job requiring repetitive use, pre-diagnosis). The results for Dupuytren's and Dual patients (all Dupuytren's patients) are quite similar in that over 55% of patients report having had a hand issue. Interestingly however if we use the Ledderhose patients as a control group we see a much lower percentage of patients report having had any issues with their hands. This suggests that within a Dupuytren's and Ledderhose patient group those with trauma to their hands are more likely to have developed Dupuytren's. 

Graph 2: Percentage of patient groups with or without a foot issue. 

The results of graph 2 are the same principle as graph 1 but the Ledderhose patients are on the left and Dupuytren's on the right. Here there appears to be no correlation between foot usage and the likelihood of Ledderhose development. 

Graph 3: Break down of levels of each foot factor.

Graph 3 is then a breakdown of each of the factors considered for the foot, this is to see whether any of these by themselves show a higher level of association with Ledderhose. Although there appears to be an increased level of high heel usage in female Ledderhose patients compare to Dupuytren's patients the difference and number of responses to the survey are too low to say if this is significant. Looking at the numbers I feel this is unlikely to be significant but this cannot be confirmed without more participants. 

As a final note I wanted to show how few Ledderhose only patients there are. This survey was shared on multiple groups and pages consisting of both Ledderhose and Dupuytren's patients, however less than 15% of patients have Ledderhose alone, 35% have both and just over 50% have Dupuytren's. This data matches that expected based on the large survey being conducted and it will be interesting to see whether, for example, the current age of the Ledderhose patients is on average lower than those with both. 

Summary:

Dupuytren's patients show a higher level of hand trauma and or use than non-Dupuytren's patients, Ledderhose patients do not show a higher level of high heel use, trauma, running or high use of feet jobs.

News, results and another survey

Recent weeks have been very interesting. Although I have not posted many blog posts or particularly had many page-views I have been fairly active. Instead of my usual activities I have been trying to raise awareness, this is not something that is easy to do for a rare non-life-threatening condition however I have had some success.

I have had interest from 2 local papers, one is hopefully going to publish an article this week and the other one I will contact again once we have had sufficient time to see if a Dupuytren’s patient that has had Xiapex can be found. The other development is that I had BBC over to interview me yesterday and they are going to run a piece on BBC South East today, including an interview with Dr Shaffer and this may then lead to a post on the BBC website. How amazing would it be to have an article on Ledderhose on the BBC website potentially linking to this blog and Dr Shaffer’s website? They did make clear that this is only a maybe but that is still a better situation that we were in last week.

Hopefully the media exposure will not stop there and I can use this momentum to try and get something out there that doesn't just cover the South-East, any ideas or contact you have are of course welcome.

Don’t forget that the deadline for submission of patient information for the survey is fast approaching and if you haven’t already filled it out it would be great to have as many responses as possible.  esurv.org/?u=dupled 

I am still collected results for the following mini-surveys as well, it would be great to have more information on these to get a better understanding of any significance or not in the results:

Plantar Fibroma and Plantar Fasciitis

Actually look like that is the only one as the initial look into the blood types showed no real difference and doesn't look like it warrants further investigation.

Preliminary results from the large survey appear to indicate that Dupuytren’s, as expected has a higher incidence in men but conversely Ledderhose has a higher incidence in women (or at least more women with Ledderhose have responded). This doesn't surprise me as I have probably been contact by more women than men however it does give rise to an interesting questions, why?

I can’t remember the exact figures but it was something like 55:45 men women for DD and vice versa for Ledderhose, numbers this close suggest to me that it is not likely to be the genetic element that plays a role meaning it could be environmental.

Graph outline the total percentage of male and female respondents with either DD or LD

The classic example here would be trauma, in men the example is that the hands are injured during manual labour and careers such as working in a mine or using the large power drills are thought to have an impact, some people have even noted a high level of musicians in Dupuytren’s patients. So what could be causing this for Ledderhose that provides an increased risk to women?

I have tried to think outside of the obvious and I am willing to have suggestions however the only thing that came to mind was that women almost exclusively wear high heels and perhaps his could account for the difference. After all we are only looking for something to account for the 10% difference in Dupuytren’s, so it could be that (purely hypothetical numbers) 80% of Dupuytren’s and Ledderhose patients are not caused by trauma and therefore you have 40% women and 40% man. In the remaining 20% we then see the difference, where for Dupuytren’s trauma is more likely in a man so this leads to the 55:45 split in favour of men whilst in Ledderhose trauma to the foot is more likely in women so you get the 55:45 split in favour of women. Something that can be discussed much more in the future when all results are in however I would love to start asking patients whether they have had any trauma etc to see whether can find any relevance.

So here is a short survey so that we can look at this

Entries are also still open for the blog awards, you can vote for me here.

Progress on the Ledderhose disease patient guide is slow going, for some treatments I am still trying to get more people, mainly surgeons, involved but I am hoping that the end of next year is a realistic target if I find time to really get my teeth into it. 

I am currently collecting the results of the patient series for this month and hopefully will have them all ready for the weekend so I can share how everyone else is getting. 

Hope every one is finding something that helps their feet, for those in the UK be sure to keep your feet warm for the winter, I always find the cold makes it hurt that little but more.