Survey of Ledderhose treatments

We have recently done a survey at the BDS, well we have started one and we are hoping for lots of Ledderhose and Dupuytren's patients to take part, you can go here to take it. So far we have had 90 participants which is better than I was expecting but worse than I was hoping for, a couple of hundred in total maybe ambitious but would making the data more useful. I think longer term it would be great if we could come up with a more definitive and useful survey and ask doctors around the world, though mainly UK (seeing as it would be a BDS thing) to send them out when they do a 1 year review with their patients. 

Still our initial survey was looking at risk factors and treatment options. There was nothing too obvious from the risk factor questions. But people had quite strong opinions on the different treatment options. Below I will only show the results for the response for Ledderhose patients but to see the full set of results so far please go to the BDS Blog.

The above graph shows the three different types of treatments that Ledderhose patients had had, Radiotherapy (blue), Surgery (Green) and Steroid injections (Orange). The first two bits on the left show whether the conditions come back or not, the middle columns shows the average time before it comes back and then on the right are two columns showing whether the patients would recommend the treatment or not. So as you can see: 

• In surgery patients (7) it came back in 5 patients at an average time of 2.5 years. Of those 7 patients only 1 would recommend and 5 said to avoid surgery. 
• For radiotherapy there were also 7 patients. In no patients did it come back and all 7 patients would recommend it. 
• There was only 1 steroid injection patient, they did not have it come back (note that I did have a steroid injection and it did come back but didn't think of it as a proper treatment so didn't include it in the survey) and they would recommend that treatment.

Overall the above data, although from few patients, seems to back what I have seen in the patients that I have interview, that being that the option of surgery is not a great one but that having radiotherapy is seen as the preferred option for a lot of patients.

Interesting post on Podiatry Today

Today I am looking at an on-line article that has been pointed out to me by one of my followers, it is a fairly interesting article on Ledderhose that has been posted on a prominent US website, their main points of discussion are the conservative treatments against surgery and they do manage to discuss a lot of the different options including Xiapex, steroid, orthotics etc although sadly there is no mention of radiotherapy. If this is something you are interested in I really recommend reading the original article, it is very interesting

The full article can be found here: 

http://www.podiatrytoday.com/point-counterpoint-conservative-care-best-approach-plantar-fibromatosis

I am going to try and pick out some of the interesting points that I came across whilst reading this, although I don’t think there was anything new to me in this article it is always good to refresh your memory on interesting things: Note I am not putting much and you really should read the article, I don't want to copy it too much as the article itself is really very good.

(Points made by first person – pro conservative treatment)

• There have been no reported studies on the effectiveness of topical transdermal verapamil or intralesional verapamil injections for plantar fibromatosis.
• With steroid injections one of the authors finds that: the nodules consistently soften and shrink (although they seldom resolve entirely), and the symptomatology resolves.
• The effectiveness of collagenase was approx. 65%.
• Recurrence rate after local surgery ranged from 40-100%.

(Points made by second person – not pro conservative treatment)

•  It is my opinion that early on when there is a small isolated nodule, conservative care can be effective but once there is a coalescence of these nodules or they become bigger than 1 cm in depth, conservative management is ineffective and frankly is rarely even palliative. When patients cannot walk because of the pain, the only option becomes surgical intervention for a consistent, predictable outcome.
• I have had much more predictable results with surgical intervention than with conservative management. (My question would be --does predictable mean good?)
• The vast majority of the nodules involve the central band of the plantar fascia and can be large enough to cause compression neuropathy to the medial plantar nerve. (Think this is what happened to me, he says that surgery is only way to stop permanent damage, well radiotherapy seems ok so far).

There is loads of information in the original article that I have not included here and much of it is referenced very well and they look at loads of great papers and articles that have appeared over the year and I really recommend going to the original website and having a look.