Ledderhose disease is a type of plantar fibromatosis characterized by the growth of hard and round or flattened nodules (lumps) on the soles of the feet. La enfermedad de Ledderhose es una hiperproliferación benigna de fibroblastos y colágeno a nivel de la aponeurosis plantar. Patología de baja incidencia y. Fibromatosis plantar o enfermedad de Ledderhose, como causa de dolor plantar. Authors: JdD. Beas-Jiménez, R.A. Centeno-Prada, C. García-Antúnez, M.D.
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In radiation therapy, the nodules and cords associated with Dupuytren’s are irradiated from a distance of. After a break of leddergose weeks, this treatment is repeated. Recently research showed that a total dose of 20 Gy has nearly the same effect see literature. Prior to radiotherapy the to be irradiated area has to be defined by the physician.
Because RT is usually not repeated it is very important that all sites of Dupuytren’s in the hand are identified and included within the irradiated area.
At the same time not diseased areas are usually not irradiated to minimize risk of cancer and to allow later treatment in case DD should start in those areas.
MRIs are rarely required for diagnosis but an experienced physician will be able to palpate even tiny nodules and cords. Below picture illustrates the difference between a patients finding left the result of the physician’s palpation right. Nodules and cords identified by the patient left and the additional findings of the physician right. Picture published with agreement by the patient and H.
Seegenschmiedt, Strahlenzentrum Hamburg Nord, Germany. Where radiotherapists have limited experience in diagnosing Dupuytren’s it might be feasible to consult an experienced hand surgeon for marking the nodules. Setup for radiation therapy of Dupuytren’s disease Dupuytrens with X-rays.
The patient is shielded from radiation by the equipment itself, by a lead mask between the x-ray conus and the hand defining the radiated areathe material under the hand, and the lead apron. Picture provided by H. Radiotherapy is capable of stopping the growth of Dupuytren nodules enfermwdad permanently or for a long ledderhosd. Below is a graph from a presentation by Seegenschmiedt et al. Blue lines indicate the disease progression after radiotherapy, the dotted line indicates a potential healing effect in early stage treatment for details please refer to the full presentation.
The effectiveness of radiotherapy depends on the stage of the disease.
It is very promising in the early nodular stage where the nodules are relatively small. If it doesn’t, surgeryNA or collagenase injection are still possible. Long-term results from Betz et al.
It is important to understand that not every patient with Dupuytren’s nodules will experience contracture. People who develop initial signs of Dupuytren’s at the age of 70 or later will often not need treatment at all. Clear guidelines for who should be treated by radiotherapy and who not are still missing. Treatment by radiotherapy probably makes sense for patients with aggressive Dupuytren’s where RT can slow down or halt disease progression and who otherwise would have to face later surgery or frequent minimally invasive treatments.
The aggressiveness of Dupuytren’s disease may depend on several factors, one of them being age. Patients with a dormant disease or low probability for recurrence might get along well with a “wait and see” strategy. As radiotherapy of Dupuytren and Ledderhose disease often also relieves pain, patients suffering from painful disease might also be potential candidates for radiotherapy.
Additional detailed consideration and information on radiotherapy specifically at a Hamburg clinic are provided by a patient Alastair Cook on dupuytrensradiotherapy. Dupuytren’s disease and Ledderhose disease start with fibrous tissue in form of nodules that, specifically in its initial stage, is biologically very active “proliferative”.
Like in wound healing this tissue maturates building cords for Dupuytren’s and eventually contracts actively or passively fixing a contraction. The initial proliferating stage is engermedad suitable for radiotherapy. Radiotherapy seems to be able to affect the development of the involved fibroblast and myofibroblast cells in other terms the involved growth factors and reduce their growth rate. There is indication that this is achieved by affecting the development paths of the myofibroblast cells.
As the growth of a nodule is the net effect of building new cells and of removing dead cells, the slowing down of the growth of new cells can result in shrinking and softening of the nodule.
For more details please refer to ” Introduction to ledderhoes biology when treating hyperproliferative benign diseases ” linkor literature section 9. Above comments apply for Ledderhose accordingly. Because Ledderhose shows less cords but mostly larger nodules, radiation therapy is applied to those larger nodules as well. Below is an example of an x-ray treatment showing how lead shielding is applied for limiting the radiated area shielding of electron beams is more difficult, therefore typically the whole area is radiated.
Below pictures were provided by Dr. Marking of nodule dotted, center and to be radiated area prior to treatment. Protecting the surrounding area with a lead shield prior to x-ray treatment. Before radiotherapy the nodule or nodules extend over a large area of the arch.
Plantar fibromatosis | Radiology Reference Article |
After radiotherapy the nodule is lesderhose gone but reduced in size. Even the walking difficulties and pain got much better. An expert diagnosis prior to radiotherapy is important!
Seegenschmiedt, Strahlenzentrum Hamburg Nord, Germany Where radiotherapists have limited experience in diagnosing Dupuytren’s it might be feasible to consult an experienced hand surgeon for marking the nodules. The irradiated area is marked on the hand. The hand is ready for treatment. Note that there is no shielding required.