Zusammenfassung
Der Morbus Ledderhose ist eine seltene fibromatöse Erkrankung der Plantarfaszie. Die knotigen Indurationen oder Strangbildungen treten solitär oder multipel auf. Die Hauptlokalisation ist im mittleren Drittel der Plantaraponeurose lokalisiert. Bei geringer klinischer Beschwerdesymptomatik kann ein konservativer Therapieversuch mit maßgefertigten Schuheinlagen, systemischer Gabe nicht steroidaler Antiphlogistika, lokalen Kortisoninjektionen und physiotherapeutischen Anwendungen unternommen werden. Die Operationsindikation zur Behandlung der Plantarfibromatose besteht bei persistierenden, therapierefraktären Beschwerden. Dabei erfolgt als Primäreingriff meist eine partielle Aponeurektomie mit Resektion des fibromatös veränderten Gewebes. Rezidive sind danach häufig und besitzen eine höhere Komplikationsrate bei gleichzeitig aggressiverem Wachstum. Deshalb empfehlen wir nicht nur für die Rezidivbehandlung, sondern bereits für den Primäreingriff die totale Fasziektomie.
Abstract
Morbus Ledderhose is a rare fibromatous disease of the plantar fascia. Clinical features include palpable solitary or multiple nodules and cords, mainly affecting the medial part of the plantar fascia. When clinical symptoms occur, conservative options include stretching, orthotics, nonsteroidal antirheumatic drugs, local cortison-injections and physiotherapy. Operative treatment is indicated in case of persistent pain or if conservative measures fail. The standard procedure includes a partial fasciectomy of the plantar aponeurosis. There is a high recurrence rate with an increased risk of complications and more aggressive ingrowth into anatomical structures after partial resection. Therefore we recommend a complete fasciectomy not only in recurrent disease, but also as the primary procedure of choice.
Schlüsselwörter
Plantarfibromatose - Morbus Ledderhose - Rezidiv - Fasziektomie
Key words
Plantar fibromatosis - Morbus Ledderhose - recurrence - total plantar fasciectomy
Literatur
-
1
Alexander I J, Johnson K A, Shives T C, Reiman H M, Johnson J E.
Aggressive fibromatosis of the plantar aspect of the foot. A case report.
Bull Hosp Jt Dis Orthop Inst.
1987;
47
103-108
-
2
Allen R A, Woolner L B, Ghormley R K.
Soft tissue tumors of the sole with special reference to plantar fibromatosis.
J Bone Joint Surg [Am].
1955;
37
14-26
-
3
Aluisio F V, Mair S D, Hall R L.
Plantar fibromatosis: treatment of primary and recurrent lesions and factors associated with recurrence.
Foot Ankle Int.
1996;
17
672-678
-
4
Bedi D G, Davidson D M.
Plantar fibromatosis: most common sonographic appearance and variations.
J Clin Ultrasound.
2001;
29
499-505
-
5
Bunker T D, Anthony P P.
The pathology of frozen shoulder. A Dupuytren-like disease.
J Bone Joint Surg [Br].
1995;
77
677-683
-
6 Campanacci M. Palmar and plantar fibromatosis. Bone and soft tissue tumors. Springer, Wien, New York 1989; 1067-1069
-
7
Classen D A, Hurst L N.
Plantar fibromatosis and bilateral flexion contractures: a review of the literature.
Ann Plast Surg.
1992;
28
475-478
-
8
Curtin J W.
Fibromatosis of the plantar fascia; surgical technique and design of skin incision.
J Bone Joint Surg [Am].
1965;
47
1605-1608
-
9
Daly P J, Kitaoka H B, Chao E Y.
Plantar fasciotomy for intractable plantar fasciitis: clinical results and biomechanical evaluation.
Foot Ankle.
1992;
13
188-195
-
10
de Almeida H L, Wolter M, Neugebauer M G, Neugebauer S.
Plantarfibromatose mit ausgedehnter kutaner Beteiligung.
Hautarzt.
2001;
52
236-239
-
11
de Palma L, Santucci A, Gigante A, Di Giulio A, Carloni S.
Plantar fibromatosis: an immunohistochemical and ultrastructural study.
Foot Ankle Int.
1999;
20
253-257
-
12
Donato R R, Morrison W A.
Dupuytren's disease in the feet causing flexion contractures in the toes.
J Hand Surg [Br].
1996;
21
364-366
-
13
Durr H R, Krodel A, Trouillier H, Lienemann A, Refior H J.
Fibromatosis of the plantar fascia: diagnosis and indications for surgical treatment.
Foot Ankle Int.
1999;
20
13-17
-
14 Enzinger F M, Weiss S W. Fibromatoses. Soft Tissue Tumors. C. V. Mosby, St. Louis 1988; 45-52
-
15
Evans H L.
Multinucleated giant cells in plantar fibromatosis.
Am J Surg Pathol.
2002;
26
244-248
-
16
Farsetti P, Tudisco C, Caterini R, Bellocci M.
Ledderhose's disease: case study with histologic and ultrastructural analysis.
Ital J Orthop Traumatol.
1992;
18
129-133
-
17
Gabbiani G, Majno G.
Dupuytren's contracture: fibroblast contraction? An ultrastructural study.
Am J Pathol.
1972;
66
131-146
-
18
Griffith J F, Wong T Y, Wong S M, Wong M W, Metreweli C.
Sonography of plantar fibromatosis.
Am J Roentgenol.
2002;
179
1167-1172
-
19
Haedicke G J, Sturium H S.
Plantar fibromatosis: an isolated disease.
Plast Reconstr Surg.
1988;
83
296-300
-
20
Hedrick M R.
The plantar aponeurosis.
Foot Ankle Int.
1996;
17
646-649
-
21 Hueston J T. Dupuytren's contracture. Churchill Livingstone, Edinburgh, London 1963
-
22
Landers P A, Yu G V, White J M, Farrer A K.
Recurrent plantar fibromatosis.
J Foot Ankle Surg.
1993;
32
85-93
-
23
Lee T H, Wapner K L, Hecht P J.
Plantar fibromatosis.
J Bone Joint Surg [Am].
1993;
75
1080-1084
-
24
Morrison W B, Schweitzer M E, Wapner K L, Lackman R D.
Plantar fibromatosis: a benign aggressive neoplasm with a characteristic appearance on MR images.
Radiology.
1994;
193
841-845
-
25
Parnitzke B, Decker O, Neumann U.
Morbus Ledderhose. Die plantare Fibromatose - klinische Aspekte.
Zentralbl Chir.
1991;
116
531-534
-
26
Rao G S, Luthra P K.
Dupuytren's disease of the foot in children; a report of three cases.
Br J Plast Surg.
1988;
41
313-315
-
27
Recht M P, Donley B G.
Magnetic resonance imaging of the foot and ankle.
J Am Acad Orthop Surg.
2001;
9
187-199
-
28
Sammarco G J, Mangone P G.
Classification and treatment of plantar fibromatosis.
Foot Ankle Int.
2000;
21
563-569
-
29
Solivetti F M, Luzi F, Bucher S, Thorel M F, Muscardin L.
La fibromatosi plantare: risultati ecografici.
Radiol Med.
1999;
97
341-343
-
30
Wapner K L, Ververeli P A, Moore J H, Hecht P J, Becker C E, Lackman R D.
Plantar fibromatosis: a review of primary and recurrent surgical treatment.
Foot Ankle Int.
1995;
16
548-551
-
31
Wu K K.
Plantar fibromatosis of the foot.
J Foot Ankle Surg.
1994;
33
98-101
Dr. med. Johannes Beckmann
Orthopädische Klinik der Universität Regensburg
Kaiser-Karl-V.-Allee 3
93077 Bad Abbach
Telefon: 0 94 05/18-48 43
Fax: 0 94 05/18-29 25
eMail: j.beckmann@rheuma-ortho-zentrum.de
