Background: Ledderhose Disease, or plantar fibromatosis, is a fibroproliferative disorder affecting the plantar fascia with limited effective treatment options. Although hyaluronidase has a long history of clinical use, it has not been previously used for Ledderhose Disease. This study explores the use of combined hyaluronidase and triamcinolone acetonide enzymatic injections as a novel and promising technique for managing Ledderhose Disease. Methods: This paper investigates the use of combination therapy with hyaluronidase, triamcinolone acetonide, and lidocaine injections in three patients with Ledderhose Disease. Injection protocols, dosage, frequency, and patient outcomes are all discussed. Additionally, this study explores the underlying mechanisms of hyaluronidase action in Ledderhose Disease, shedding light on its potential to modulate fibrotic tissue and alleviate symptoms. Results: All three patients treated with a series of hyaluronidase, triamcinolone acetonide, and lidocaine anesthetic injections experienced either a significant reduction in or elimination of nodules and associated pain within 6 weeks after initial injection. Patients were asymptomatic at two years follow-up after injections. Conclusions: The combination of hyaluronidase and triamcinolone acetonide injections significantly decreased pain and softened fibromas faster than triamcinolone acetonide injection alone, as explored in previous studies. Large prospective studies are needed to further compare enzymatic injection therapies in the management of Ledderhose Disease.

Plantar fibromatosis, also known as Ledderhose disease, is a rare benign fibroproliferative disorder of the plantar fascia, characterized by the development of slowly growing nodules that may become painful and functionally limiting. Although the diagnosis is often suspected clinically, imaging-particularly ultrasound-plays an important role in confirming the diagnosis and guiding management. We report the case of a 57-year-old man presenting with bilateral plantar nodules, in whom ultrasound enabled diagnostic confirmation and guided corticosteroid injection. Conservative management combining ultrasound-guided injection, custom orthotic insoles, and a targeted rehabilitation program resulted in complete pain relief and a reduction in nodule size at short-term follow-up. This case illustrates the diagnostic and interventional value of ultrasound in the nonsurgical management of plantar fibromatosis.

Plantar fibromatosis (PFI) is a rare condition that affects the plantar aponeurosis resulting in painful nodules on the foot/feet. There are no clinical guidelines for treatment in the United States, and real-world evidence regarding treatment patterns is limited. This retrospective cohort study used linked data from adjudicated claims and electronic medical records to identify patients with incident PFI. PFI prevalence in 2021 was estimated, and treatment patterns for conservative (nonsurgical) and surgical interventions were assessed during the 24 months after diagnosis. Age- and sex-adjusted PFI prevalence was 57.03 cases per 100,000 in 2021. In the incident PFI cohort (N = 620), 392 patients (63.23%) were female. During the 12-month baseline period before diagnosis, 19.03% of patients had evidence of foot/ankle pain or stiffness, and 53.55% received prescribed analgesics or steroids. Most patients (91.13%) received conservative treatment during follow-up, including injectable corticosteroids (59.19%), oral corticosteroids (44.68%), and physical/occupational therapy (PT/OT, 40.81%). On average, treated patients had 2.10 oral and 2.63 injectable steroid claims and 15.8 PT/OT visits during follow-up. Surgical interventions were rarely used (n = 42; 6.77%); excision of foot tumor (n = 15/42; 35.71%) was the most common surgical procedure. Following surgery, conservative treatments were commonly observed (n = 39; 92.86%). Our findings suggest patients newly diagnosed with PFI typically received conservative treatments. Although surgery is infrequent, conservative treatments often continue after surgery, which may suggest disease recurrence or persistent symptoms. Additional studies are warranted to develop an understanding of long-term clinical and patient-reported outcomes with/without treatment, among patients with refractory disease.

Plantar fibromatosis, or Ledderhose disease, is a rare benign fibroproliferative disorder of the plantar fascia characterized by the development of fibrous nodules, which may cause pain and functional limitation. Although the exact etiology remains unclear, it has been associated with trauma, diabetes mellitus, liver disease, epilepsy, and chronic alcohol use. Management is often conservative, but surgical intervention may be required when symptoms persist. A 32-year-old female presented with a six-month history of painful nodules on the medial aspect of her left sole. Clinical examination and ultrasonography revealed three hypoechoic nodules within the plantar fascia. Initial conservative treatment with nonsteroidal anti-inflammatory drugs (NSAIDs), stretching, orthotic insoles, and physiotherapy failed to improve symptoms. Surgical excision with partial plantar fasciectomy was therefore performed. Histopathological examination confirmed the diagnosis of plantar fibromatosis, showing dense fibrocellular tissue with fibrocytic and collagenous proliferation and myofibroblastic differentiation. The postoperative recovery was uneventful, and at five-year follow-up, the patient remained pain-free with no evidence of recurrence. Plantar fibromatosis should be considered in patients presenting with firm nodules on the plantar aspect of the foot. When conservative therapy fails, partial plantar fasciectomy can provide excellent functional outcomes and long-term symptom relief with a low risk of recurrence.

Plantar fascia (PF) lesions, such as plantar fasciitis, PF tear, and plantar fibromatosis (Ledderhose disease), are among the common causes of heel pain. The management of these lesions includes conservative treatments, minimally invasive treatments, and surgical interventions. When conservative treatments fail, minimally invasive injection therapies have been proposed as alternatives for managing PF lesions. Despite the availability of various injectable options, where and how to perform the injection is still controversial in the pertinent literature. In this article, considering the paramount role of ultrasound imaging in the diagnosis, interventions, and follow-up for PF pathologies, we demonstrated our sonographic approach to PF lesions for sonographers/physicians in daily clinical practice.