Treatment

Non Operative Treatment:
- small nodules causing no pain can be left alone (4)
- pain reduction and long term relief of symptoms can be obtained using:
- night splints (adding a great toe wedge will increase stretching effect
on fascia, but can be very painful in the beginning)
- a plantar fascia stretching device
- orthotics and shoe wear modification

Expected Results with Surgery:
- high incidence (57 %) of local recurrence when only fibroma is removed (7)

Indication/Contraindication for Surgery:
- indication:
- large nodules causing pain or nerve compression, with no improvement by stretching/splinting/shoe wear
modification
- contraindication:
- bad vascular status of foot (vascular disease, microvascular disease)

Surgical Approach: wide resection of nodules + surrounding macroscopically 'normal' fascia
- longitudinal incision along medial-plantar aspect of first metatarsal (Pederson and Day) (6)
- proximally to the tarsal navicular
- development of skin flaps to expose the fibroma and fascia
- aggressive excision of lesion + normal appearing adjacent fascia
- tack down skin flaps to prevent hematoma
- close on suction tubes lying beneath the skin
- Postoperative Management:
- firm compression dressing
- protected weight bearing in postop shoe as soon as pain permits

Recurrence:
- in case of recurrence and lots of pain: complete fascial excision

Surgical treatment for Ledderhose

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