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Health condition · Clinically reviewed

Ledderhose disease, plantar fibromatosis — stratified from observation to radiotherapy.

Benign fibrous nodules in the plantar fascia. Often coexists with Dupuytren’s contracture. Treatment is stratified by symptoms — from insoles and steroid + verapamil injections to radiotherapy for progressive disease and surgery as a last resort.

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A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Every claim is checked against BOFAS, Dupuytren’s Society UK and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects current UK practice on orthoses, steroid + verapamil injections, radiotherapy and selective surgery.

Key facts

Ledderhose disease at a glance.

The essentials, in plain English — what Ledderhose disease is, how it sits alongside Dupuytren’s and Peyronie’s, and what the evidence says actually helps.

  • Definition

    Plantar fibromatosis — Ledderhose disease — is a benign fibrous nodular thickening of the plantar fascia, part of the superficial fibromatosis family.

  • Bilateral disease

    Bilateral in around 25% of cases — both feet can develop nodules over time, though severity often differs.

  • Fibromatosis cluster

    Often coexists with Dupuytren’s contracture of the hand and Peyronie’s disease — a shared superficial fibromatosis tendency.

  • No flexion deformity

    Unlike Dupuytren’s, Ledderhose rarely causes toe flexion contractures — the pathology is nodular rather than contractile.

  • Radiotherapy has evidence

    Low-dose radiotherapy has meaningful evidence for early proliferative disease — slowing progression before nodules become symptomatic surgery candidates.

  • Surgery is a last resort

    Partial fasciectomy carries high recurrence and wound-healing risk and is reserved for select disabling cases.

Why this guide matters

Stratify by symptoms, not by nodule size.

Ledderhose management is genuinely stratified — many nodules need only offloading and monitoring, and reaching for surgery too early causes more problems than it solves.

  • Orthoses do a lot of the work

    Silicone gel insoles and custom orthoses offload nodules — a cheap, immediate and evidence-backed first line for symptomatic disease.

  • Radiotherapy has a real role early

    For early, proliferative Ledderhose there is meaningful evidence that low-dose radiotherapy slows progression before surgery is on the table.

  • Surgery sits at the end, not the start

    Partial fasciectomy carries recurrence and wound-healing risks — it is a considered last resort, not a routine step.

How the diagnosis is made

From arch nodule to a clear plan.

The steps a UK GP, podiatrist or foot and ankle specialist will normally follow, in order — so you know what to expect and why.

  1. 01

    Recognising

    Symptom + fibromatosis history

    A firm arch nodule with or without pain — take a family and personal history of Dupuytren’s or Peyronie’s, which cluster with Ledderhose.

  2. 02

    Recognising

    Foot examination

    Palpation of the plantar fascia along the medial arch — nodules are typically firm, mobile and tethered to the fascia rather than skin.

  3. 03

    Recognising

    Ultrasound to characterise nodules

    Ultrasound reliably identifies hypoechoic fascia-based nodules and helps distinguish them from cysts, lipomas or vascular lesions.

  4. 04

    Confirming

    MRI if diagnosis uncertain

    MRI is reserved for atypical, rapidly enlarging or deep lesions — it characterises soft-tissue signal and excludes more sinister differentials.

  5. 05

    Confirming

    Rule out other causes

    Distinguish from plantar fasciitis, epidermoid cysts, ganglia and, rarely, soft-tissue sarcoma — the differential matters.

  6. 06

    Managing

    Podiatry / orthopaedic referral

    A foot and ankle podiatrist or orthopaedic surgeon can stratify treatment and coordinate injection, radiotherapy or surgical opinion.

  7. 07

    Managing

    Stratify treatment by symptoms

    From observation and orthoses for asymptomatic nodules to injection, radiotherapy or surgery for progressive, painful disease.

Typical timeline: 4–8 weeks from first appointment to a stratified plan.

Symptoms

What Ledderhose disease actually feels like.

The pattern is more telling than any single sign — palpable arch nodules, weight-bearing discomfort and, often, coexistent fibromatosis elsewhere.

  • Plantar arch nodules

    Firm, palpable lumps along the medial arch of the foot — sometimes multiple and slowly progressive.

  • Pain with weight-bearing

    Discomfort or sharp pain over nodules when standing, walking or wearing firm-soled shoes.

  • Altered gait

    Some people offload the affected arch, changing gait and putting new strain on the knee, hip or opposite foot.

  • Bilateral disease

    Around a quarter of people develop nodules in both feet — often asymmetric in size and symptom burden.

  • Coexistent Dupuytren’s

    Palmar nodules or cords of Dupuytren’s contracture may be present — a shared fibromatosis tendency.

  • Coexistent Peyronie’s

    Penile plaques of Peyronie’s disease may coexist — worth asking about sensitively where relevant.

  • Recurrence after surgery

    Nodules can recur after partial fasciectomy — a key reason surgery is reserved for genuinely disabling disease.

  • Red flag

    A rapidly enlarging, painful nodule with systemic weight loss — image with MRI and refer to exclude soft-tissue sarcoma.

Treatment

How Ledderhose disease is treated in the UK.

A staged approach — orthoses and stretching first, then image-guided steroid + verapamil, radiotherapy for early proliferative disease, and surgery reserved for genuinely disabling cases.

  • Silicone gel / custom orthoses

    Cushioned insoles and custom orthoses offload nodules and reduce pressure pain — the first-line, low-risk intervention.

  • Physiotherapy (stretching)

    Gentle plantar fascia and calf stretching maintains flexibility and supports gait — a useful adjunct to orthoses.

  • Ultrasound-guided steroid + verapamil

    Combined intralesional steroid and verapamil injection can soften nodules and ease pain — ultrasound guidance targets the lesion accurately.

  • Radiotherapy (early proliferative disease)

    Low-dose radiotherapy has real evidence for early, proliferative Ledderhose — slowing progression before nodules become surgical.

  • Collagenase (off-label, limited evidence)

    Collagenase injection is used off-label for select cases — evidence remains limited compared with Dupuytren’s of the hand.

  • Cryotherapy (specialist)

    Cryotherapy is used in a small number of specialist centres — an emerging option rather than a mainstream one.

  • Partial fasciectomy (last resort)

    Reserved for genuinely disabling, non-responsive disease — high recurrence and wound-healing risk mean it is a considered decision.

  • Post-op orthoses and rehab

    After any surgery, custom orthoses and a structured rehab plan protect the wound and support return to walking.

What this guide is based on

The sources behind every claim on this page.

UK specialist society standards, patient organisations and peer-reviewed radiotherapy evidence, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP, podiatrist or foot and ankle team knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • British Orthopaedic Foot and Ankle Society (BOFAS). Clinical standards for foot and ankle conditions.

  • Radiotherapy for Dupuytren’s and Ledderhose — evidence base and dose-fractionation reviews.

  • Dupuytren’s Society UK. Patient information on Dupuytren’s, Ledderhose and Peyronie’s disease.

  • European Journal of Radiotherapy — reviews on low-dose radiotherapy for benign fibromatoses.

Red flags

When a plantar nodule is not just Ledderhose.

Most plantar nodules are benign and behave predictably. These are the situations where a different diagnosis or a change of plan needs to be considered.

  • Rapidly enlarging painful nodule

    A nodule that grows quickly or becomes disproportionately painful — image with MRI and refer to exclude soft-tissue sarcoma.

  • Ulcerated nodule

    Skin breakdown over a plantar nodule needs prompt review — risk of infection and delayed healing, especially in older patients.

  • Diabetic foot with fibromatosis

    People with diabetes need particular care — offloading, skin surveillance and diabetic foot team review to prevent ulceration.

  • Post-op wound complications

    Wound dehiscence, infection or delayed healing after fasciectomy — contact the surgical team promptly.

  • Recurrent aggressive fibromatosis

    Aggressive or extensive recurrence after surgery — needs specialist reassessment rather than repeated similar operations.

  • Bilateral progressive disease

    Progressive bilateral disease affecting mobility — coordinated podiatry, orthotics and specialist input, not a single one-off intervention.

  • Post-radiotherapy skin changes

    Persistent skin thinning, telangiectasia or non-healing after radiotherapy — review with the treating radiotherapy team.

  • Coexistent severe Peyronie’s

    Severe Peyronie’s disease deserves its own urological assessment — do not manage in isolation from the wider fibromatosis picture.

  • Suspected desmoid tumour

    Deep, infiltrative or unusually aggressive lesions raise the differential of a desmoid tumour — image and refer for sarcoma-service opinion.

Living with it

A slow condition, but a very manageable one.

Four things that make the biggest difference day to day — footwear, rehab, watchful monitoring and patient review.

A quiet reminder

Consistency beats intensity, every time.

Small, steady changes — kept up for months — do more than a heroic week that does not last.

  1. 01 Footwear

    Cushion and offload nodules

    Silicone gel insoles or custom orthoses reduce pressure over nodules — often the single biggest daily lever.

  2. 02 Rehab

    Keep the fascia moving

    Gentle plantar fascia and calf stretching keeps the arch flexible and supports comfortable gait.

  3. 03 Watch

    Track nodule change

    Note any rapid growth, new pain or skin change — those are the triggers for a review rather than watchful waiting.

  4. 04 Reviews

    Reassess in months, not days

    This is a slow condition — reviews at 3–6 month intervals let orthoses, injections or radiotherapy work.

Frequently asked

Everything we get asked about Ledderhose disease.

Quick answers on nodules, injections, radiotherapy, surgery and when to seek help.

  • What is Ledderhose disease?

    Ledderhose disease — plantar fibromatosis — is a benign fibrous nodular thickening of the plantar fascia of the foot. It is part of the same superficial fibromatosis family as Dupuytren’s contracture of the hand and Peyronie’s disease.

  • Is Ledderhose disease the same as plantar fasciitis?

    No. Plantar fasciitis is a degenerative and inflammatory enthesopathy at the heel that causes first-step morning pain. Ledderhose disease is a nodular fibromatosis of the arch — you can feel firm lumps in the plantar fascia, and the diagnosis is confirmed on ultrasound.

  • Do the nodules always cause pain?

    Not always. Many nodules are asymptomatic and only need cushioned insoles and monitoring. Pain typically develops when nodules are large, superficial or under a pressure-bearing part of the arch.

  • Does radiotherapy actually work?

    Low-dose radiotherapy has meaningful evidence for early, proliferative Ledderhose — slowing progression and reducing symptoms before nodules reach the point where surgery is being considered. It is not helpful for burned-out, stable disease.

  • When is surgery considered?

    Partial fasciectomy is reserved for genuinely disabling, non-responsive disease. Recurrence rates and wound-healing complications are meaningful, which is why it sits at the end of the treatment ladder rather than the start.

  • What is the red flag I should not ignore?

    A rapidly enlarging, disproportionately painful nodule — especially with systemic weight loss — needs MRI and specialist review to rule out a soft-tissue sarcoma or desmoid tumour rather than assuming benign Ledderhose disease.

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