The successful use of collagenase for Ledderhose disease (plantar fibromatosis) in a paediatric patient: a case report

Abstract

Ledderhose disease is a connective tissue disorder involving proliferation of fibrous tissue in the plantar fascia of the foot. Histologically identical manifestations exist in the hand (Dupuytren's contracture) and penis (Peyronie's disease), and collagenase injections are approved as a treatment in both, however not in Ledderhose, where the treatment of choice remains surgical resection. Surgery is associated with high rates of recurrence and need for further surgery, so alternative therapies should be sought. Due to their histological and physiological similarities, it is likely that therapies useful in Dupuytren's and Peyronie's would be useful in Ledderhose. Two previous case reports investigating collagenase injections for Ledderhose disease in adults have shown conflicting results; this study demonstrates the efficacy of collagenase injections in a paediatric patient at 1-year follow-up.

Figure 1

Ultrasonographic Images demonstrating the presence of a nodule embedded in the plantar fascia.

Figure 2

Images at ×4 magnification. Tissue samples comprise of cytologically bland spindle cell proliferative features which extends into the adjacent fibrofatty tissue.

Figure 3

The cellular pattern is haphazard with areas of dense fibrosis, suggestive of fibromatosis (LD).