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de Haan A, Hijmans JM, van der Vegt AE, van der Laan HP, van Nes JGH, Werker PMN, Langendijk JA, Steenbakkers RJHM. Effect of painful Ledderhose disease on dynamic plantar foot pressure distribution during walking: a case-control study. Foot (Edinb) 2023; 56:101990. [PMID: 36905795 DOI: 10.1016/j.foot.2023.101990] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Plantar pressure distribution during walking in patients with painful Ledderhose disease is unknown. RESEARCH QUESTION Do patients with painful Ledderhose disease have an altered plantar pressure distribution during walking compared to individuals without foot pathologies? It was hypothesized that plantar pressure is shifted away from the painful nodules. METHODS Pedobarography data of 41 patients with painful Ledderhose disease (cases, mean age: 54.2 ± 10.4 years) was collected and compared to pedobarography data from 41 individuals without foot pathologies (controls, mean age: 21.7 ± 2.0 years). Peak Pressure (PP), Maximum Mean Pressure (MMP) and Force-Time Integral (FTI) were calculated for eight regions (heel, medial midfoot, lateral midfoot, medial forefoot, central forefoot, lateral forefoot, hallux and other toes) under the soles of the feet. Differences between cases and controls were calculated and analysed by means of linear (mixed models) regression. RESULTS Proportional differences in PP, MMP and FTI showed increased values for the cases compared to the controls, especially in the heel, hallux and other toes regions, and decreased values in the medial- and lateral midfoot regions. In naïve regression analysis, being a patient was a predictor for increased- and decreased values for PP, MMP and FTI for several regions. When dependencies in the data were taken into account with linear mixed-model regression analysis, the increased- and decreased values for the patients were most prevalent for FTI at the heel, medial midfoot, hallux and other toes regions. SIGNIFICANCE In patients with painful Ledderhose disease, during walking, a shift of pressure was found towards the proximal and distal foot regions, while offloading the midfoot regions.
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Affiliation(s)
- Anneke de Haan
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, the Netherlands.
| | - Juha M Hijmans
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
| | - Anna E van der Vegt
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
| | - Hans Paul van der Laan
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, the Netherlands
| | | | - Paul M N Werker
- University of Groningen, University Medical Center Groningen, Department of Plastic Surgery, Groningen, the Netherlands
| | - Johannes A Langendijk
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, the Netherlands
| | - Roel J H M Steenbakkers
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, the Netherlands
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de Haan A, van Nes JGH, Kolff MW, van der Toorn PP, Westenberg AH, van der Vegt AE, Groen H, Overbosch J, van der Laan HP, Werker PMN, Langendijk JA, Steenbakkers RJHM. Radiotherapy for Ledderhose disease: Results of the LedRad-study, a prospective multicentre randomised double-blind phase 3 trial. Radiother Oncol 2023; 185:109718. [PMID: 37211283 DOI: 10.1016/j.radonc.2023.109718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND AND PURPOSE Radiotherapy is considered a treatment option for Ledderhose disease. However, its benefits have never been confirmed in a randomised controlled trial. Therefore, the LedRad-study was conducted. MATERIALS AND METHODS The LedRad-study is a prospective multicentre randomised double-blind phase three trial. Patients were randomised to sham-radiotherapy (placebo) or radiotherapy. The primary endpoint was pain reduction at 12 months after treatment, measured with the Numeric Rating Scale (NRS). Secondary endpoints were pain reduction at 6 and 18 months after treatment, quality of life (QoL), walking abilities and toxicity. RESULTS A total of 84 patients were enrolled. At 12 and 18 months, patients in the radiotherapy group had a lower mean pain score compared to patients in the sham-radiotherapy group (2.5 versus 3.6 (p = 0.03) and 2.1 versus 3.4 (p = 0.008), respectively). Pain relief at 12 months was 74% in the radiotherapy group and 56% in the sham-radiotherapy group (p = 0.002). Multilevel testing for QoL scores showed higher QoL scores in the radiotherapy group compared to the sham-radiotherapy group (p < 0.001). Moreover, patients in the radiotherapy group had a higher mean walking speed and step rate with barefoot speed walking (p = 0.02). Erythema, skin dryness, burning sensations and increased pain were the most frequently reported side effects. These side effects were generally graded as mild (95%) and the majority (87%) were resolved at 18 months follow-up. CONCLUSION Radiotherapy for symptomatic Ledderhose disease is an effective treatment resulting in a significant pain reduction, improvement of QoL scores and bare feet walking abilities, in comparison to sham-radiotherapy.
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Affiliation(s)
- Anneke de Haan
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, the Netherlands.
| | | | - M Willemijn Kolff
- Amsterdam University Medical Center, Department of Radiation Oncology, Amsterdam, the Netherlands
| | | | | | - Annelies E van der Vegt
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
| | - Henk Groen
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Jelle Overbosch
- University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands
| | - Hans Paul van der Laan
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, the Netherlands
| | - Paul M N Werker
- University of Groningen, University Medical Center Groningen, Department of Plastic Surgery, Groningen, the Netherlands
| | - Johannes A Langendijk
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, the Netherlands
| | - Roel J H M Steenbakkers
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, the Netherlands
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Carroll P, Henshaw RM, Garwood C, Raspovic K, Kumar D. Plantar Fibromatosis: Pathophysiology, Surgical and Nonsurgical Therapies: An Evidence-Based Review. Foot Ankle Spec 2018; 11:168-176. [PMID: 29310463 DOI: 10.1177/1938640017751184] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
UNLABELLED Plantar fibromatosis (morbus Ledderhose), an extra-abdominal desmoid tumor of the plantar foot, is a rare benign hyperproliferative disorder of the plantar fascia with an unknown etiology. The main clinical characteristics include slow growing nodules on the medial and central bands of the plantar fascia, which may become painful and negatively affect ambulation. Most established conservative therapies today target symptomatic relief. As symptoms progress, therapies such as injections, shockwave ablation, radiation, and/or surgery may be required. This review aims to provide insight into the pathophysiology of this condition in addition to detailing current and investigational therapies for this disorder. Many therapies have been proven in similar conditions, which could lead to promising treatment options for plantar fibromatosis. LEVELS OF EVIDENCE Level V: Expert opinion.
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Affiliation(s)
- Paul Carroll
- Division of Podiatric Surgery, Center for Wound Healing, MedStar Georgetown University Hospital, Washington, DC (PC).,MedStar Washington Hospital Center, MedStar Georgetown Orthopedic Institute, Georgetown University School of Medicine, Washington, DC (RMH).,Children's National Medical Center, National Cancer Institute, Washington, DC (RMH).,Department of Plastic Surgery, Division of Podiatric Surgery, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, DC (CG, KR).,Department of Pathology, MedStar Washington Hospital Center, Washington, DC (DK)
| | - Robert M Henshaw
- Division of Podiatric Surgery, Center for Wound Healing, MedStar Georgetown University Hospital, Washington, DC (PC).,MedStar Washington Hospital Center, MedStar Georgetown Orthopedic Institute, Georgetown University School of Medicine, Washington, DC (RMH).,Children's National Medical Center, National Cancer Institute, Washington, DC (RMH).,Department of Plastic Surgery, Division of Podiatric Surgery, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, DC (CG, KR).,Department of Pathology, MedStar Washington Hospital Center, Washington, DC (DK)
| | - Caitlin Garwood
- Division of Podiatric Surgery, Center for Wound Healing, MedStar Georgetown University Hospital, Washington, DC (PC).,MedStar Washington Hospital Center, MedStar Georgetown Orthopedic Institute, Georgetown University School of Medicine, Washington, DC (RMH).,Children's National Medical Center, National Cancer Institute, Washington, DC (RMH).,Department of Plastic Surgery, Division of Podiatric Surgery, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, DC (CG, KR).,Department of Pathology, MedStar Washington Hospital Center, Washington, DC (DK)
| | - Katherine Raspovic
- Division of Podiatric Surgery, Center for Wound Healing, MedStar Georgetown University Hospital, Washington, DC (PC).,MedStar Washington Hospital Center, MedStar Georgetown Orthopedic Institute, Georgetown University School of Medicine, Washington, DC (RMH).,Children's National Medical Center, National Cancer Institute, Washington, DC (RMH).,Department of Plastic Surgery, Division of Podiatric Surgery, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, DC (CG, KR).,Department of Pathology, MedStar Washington Hospital Center, Washington, DC (DK)
| | - Dhruv Kumar
- Division of Podiatric Surgery, Center for Wound Healing, MedStar Georgetown University Hospital, Washington, DC (PC).,MedStar Washington Hospital Center, MedStar Georgetown Orthopedic Institute, Georgetown University School of Medicine, Washington, DC (RMH).,Children's National Medical Center, National Cancer Institute, Washington, DC (RMH).,Department of Plastic Surgery, Division of Podiatric Surgery, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, DC (CG, KR).,Department of Pathology, MedStar Washington Hospital Center, Washington, DC (DK)
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Zaragoza MV, Nguyen CHH, Widyastuti HP, McCarthy LA, Grosberg A. Dupuytren's and Ledderhose Diseases in a Family with LMNA-Related Cardiomyopathy and a Novel Variant in the ASTE1 Gene. Cells 2017; 6:E40. [PMID: 29104234 PMCID: PMC5753070 DOI: 10.3390/cells6040040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 10/07/2017] [Accepted: 10/27/2017] [Indexed: 12/23/2022] Open
Abstract
Dupuytren's disease (palmar fibromatosis) involves nodules in fascia of the hand that leads to flexion contractures. Ledderhose disease (plantar fibromatosis) is similar with nodules of the foot. While clinical aspects are well-described, genetic mechanisms are unknown. We report a family with cardiac disease due to a heterozygous LMNA mutation (c.736C>T, p.Gln246Stop) with palmar/plantar fibromatosis and investigate the hypothesis that a second rare DNA variant increases the risk for fibrotic disease in LMNA mutation carriers. The proband and six family members were evaluated for the cardiac and hand/feet phenotypes and tested for the LMNA mutation. Fibroblast RNA studies revealed monoallelic expression of the normal LMNA allele and reduced lamin A/C mRNAs consistent with LMNA haploinsufficiency. A novel, heterozygous missense variant (c.230T>C, p.Val77Ala) in the Asteroid Homolog 1 (ASTE1) gene was identified as a potential risk factor in fibrotic disease using exome sequencing and family studies of five family members: four LMNA mutation carriers with fibromatosis and one individual without the LMNA mutation and no fibromatosis. With a possible role in epidermal growth factor receptor signaling, ASTE1 may contribute to the increased risk for palmar/plantar fibromatosis in patients with Lamin A/C haploinsufficiency.
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Affiliation(s)
- Michael V Zaragoza
- UCI Cardiogenomics Program, Department of Pediatrics, Division of Genetics & Genomics, School of Medicine, University of California, Irvine, Irvine, CA 92697, USA.
- Department of Biological Sciences, School of Medicine, University of California, Irvine, Irvine, CA 92697, USA.
| | - Cecilia H H Nguyen
- UCI Cardiogenomics Program, Department of Pediatrics, Division of Genetics & Genomics, School of Medicine, University of California, Irvine, Irvine, CA 92697, USA.
| | - Halida P Widyastuti
- UCI Cardiogenomics Program, Department of Pediatrics, Division of Genetics & Genomics, School of Medicine, University of California, Irvine, Irvine, CA 92697, USA.
- Department of Biological Sciences, School of Medicine, University of California, Irvine, Irvine, CA 92697, USA.
| | - Linda A McCarthy
- Department of Biomedical Engineering and The Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California, Irvine, Irvine, CA 92697, USA.
| | - Anna Grosberg
- Department of Biomedical Engineering and The Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California, Irvine, Irvine, CA 92697, USA.
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Abstract
Morbus Ledderhose is a rare hyperproliferative disease of the plantar fascia, leading to the formation of nodules. Its origin is unknown. No causal therapy is available, and treatment remains symptomatic. Various therapeutic strategies to alleviate symptoms are available and are adapted to the severity of the disease. In early stages, conservative therapy including nonpharmacological, physical, and pharmacological treatments is applied. If the disease progresses, irradiation of the plantar surface, injections of steroids, shock wave therapy, and partial or complete fasciectomy as an ultimate therapy may be indicated. Novel experimental treatment options including application of fibrinolytic agents are currently being tested, but no controlled, randomized long-term studies are available. This review aims to provide a systematic overview of current established procedures and outlines novel experimental strategies for the treatment of morbus Ledderhose, including future avenues to treat this rare disease.
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Affiliation(s)
- Nils T Veith
- Institute of Anatomy, Saarland University, Homburg, Germany
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7
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Werker PMN, Pess GM, van Rijssen AL, Denkler K. Correction of contracture and recurrence rates of Dupuytren contracture following invasive treatment: the importance of clear definitions. J Hand Surg Am 2012; 37:2095-2105.e7. [PMID: 22938804 DOI: 10.1016/j.jhsa.2012.06.032] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 06/26/2012] [Accepted: 06/27/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE To call attention to the wide variety of definitions for recurrence that have been employed in studies of different invasive procedures for the treatment of Dupuytren contracture and how this important limitation has contributed to the wide range of reported results. METHODS This study reviewed definitions and rates of contracture correction and recurrence in patients undergoing invasive treatment of Dupuytren contracture. A literature search was carried out in January 2011 using the terms "Dupuytren" AND ("fasciectomy" OR "fasciotomy" OR "dermofasciectomy" OR "aponeurotomy" OR "aponeurectomy") and limited to studies in English. RESULTS The search returned 218 studies, of which 21 had definitions, quantitative results for contracture correction and recurrence, and a sample size of at least 20 patients. Definitions for correction of contracture and recurrence varied greatly among articles and were almost always qualitative. Percentages of patients who achieved correction of contracture (ie, responder rate) when evaluated at various times after completion of surgery ranged from 15% to 96% for fasciectomy/aponeurectomy. Responder rates were not reported for fasciotomy/aponeurotomy. Recurrence rates ranged from 12% to 73% for patients treated with fasciectomy/aponeurectomy and from 33% to 100% for fasciotomy/aponeurotomy. Review of these reports underscored the difficulty involved in comparing correction of contracture and recurrence rates for different surgical interventions because of differences in definition and duration of follow-up. CONCLUSIONS Clearly defined objective definitions for correction of contracture and for recurrence are needed for more meaningful comparisons of results achieved with different surgical interventions. CLINICAL RELEVANCE Recurrence after surgical intervention for Dupuytren contracture is common. This study, which evaluated reported rates of recurrence following surgical treatment of Dupuytren contracture, provides clinicians with practical information regarding expected long-term outcomes of surgical treatment choices. TYPE OF STUDY/LEVEL OF EVIDENCE Economic and decision analysis III.
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Affiliation(s)
- Paul M N Werker
- University of Groningen, University Medical Centre Groningen, The Netherlands.
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8
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Marchalik D, Lipsky A, Petrov D, Harvell JD, Milgraum SS. Dermatologic Presentations of Orthopedic Pathologies. Am J Clin Dermatol 2012; 13:293-310. [DOI: 10.2165/11595880-000000000-00000] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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9
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Nair DS, Benbow DS, Wile DD, Gill PG. Plantar fibromatosis in diabetes. PRACTICAL DIABETES 2012. [DOI: 10.1002/pdi.1650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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10
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Abstract
To properly treat soft tissue tumors, the foot and ankle surgeon must start with an adequate fund of knowledge and follow a systematic approach. Some malignant soft tumors have a predilection for the foot and ankle, and they may mimic common musculoskeletal conditions, leading to a trap for the unwary clinician. This review will familiarize the practitioner with the common soft tissue tumors that occur in the foot and ankle along with their presentations. A systematic approach to the workup is outlined, which is designed to establish the diagnosis with a significant degree of certainty before the surgical treatment of the tumor is planned. A practical and reliable method of distinguishing benign tumors from those that are potentially malignant is presented. Finally, the techniques for surgical management of the common soft tissue tumors are summarized.
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Affiliation(s)
- Henry DeGroot
- Newton Wellesley Hospital, Newton, Massachusetts 02462, USA.
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Abstract
Plantar fibromatosis is defined as a benign fibrous disorder involving the plantar aponeurosis. Although its incidence is well described on the hands, it is less commonly seen on the feet, and its etiology is unknown. A differential diagnosis for the heel pain along the medial arch could be a benign thickening of the plantar fascia associated with plantar fibromatosis. Its high recurrence after surgical excision and problematic scarring and wound presents a significant challenge to the reconstructive foot and ankle surgeon. This article reviews the history, clinical presentation, pathologic findings, and surgical approaches to the treatment of plantar fibromatosis.
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Affiliation(s)
- Thomas Zgonis
- Connecticut Reconstructive Foot Surgeons, 21 Woodland Street, Suite 221, Hartford, CT 06105, USA.
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12
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DeBrule MB, Mott RC, Funk C, Nixon BP, Armstrong DG. Osseous metaplasia in plantar fibromatosis: a case report. J Foot Ankle Surg 2004; 43:430-2. [PMID: 15605059 DOI: 10.1053/j.jfas.2004.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A case report about extensive osseous metaplasia of a plantar fibromatosis is presented. The authors are unaware of previous reports in the literature describing osseous metaplasia within plantar fibromatosis in this manner. This case shows that plantar fibromatosis may undergo osseous metaplasia in a fashion similar to fibromatous lesions elsewhere.
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Affiliation(s)
- Michael B DeBrule
- Department of Surgery, Southern Arizona Veterans Affairs Medical Center, USA
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13
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de Bree E, Zoetmulder FAN, Keus RB, Peterse HL, van Coevorden F. Incidence and treatment of recurrent plantar fibromatosis by surgery and postoperative radiotherapy. Am J Surg 2004; 187:33-8. [PMID: 14706583 DOI: 10.1016/j.amjsurg.2002.11.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The incidence of plantar fibromatosis (PF) is unknown. Sometimes PF tends to recur repetitively after surgical treatment. In our institute we have used postoperative radiotherapy in an attempt to diminish the change on recurrence. METHODS The Dutch Network and National Database for Pathology (PALGA) was consulted to establish the incidence of plantar fibromatosis (PF). Data from 9 patients (11 feet) with PF referred to our institute for recurrent disease were analyzed and the role of postoperative radiotherapy in prevention of recurrence was studied. RESULTS An average of 1.2 operations for PF was performed per 100,000 citizens yearly in the Netherlands. Twenty-six operations were performed and postoperative radiotherapy was used in 6 cases. Plantar fasciectomy was associated with the lowest recurrence rate. After microscopically incomplete excision or excision of early recurrence (< or =6 months) alone all tumors recurred, while recurrence was rarely observed after adjuvant radiotherapy. However, radiotherapy was associated with significantly impaired functional outcome in 3 cases. CONCLUSIONS Plantar fibromatosis is relatively rare. Plantar fasciectomy seems to be the operation of choice. Although effective in decreasing the recurrence rate, adjuvant radiotherapy should be used very selectively because of its serious side effects.
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Affiliation(s)
- Eelco de Bree
- Department of Surgical Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Huis, Plesmanlaan 121, 1066 CX Amsterdam, Netherlands
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Ho CF, Chiou HJ, Chou YH, Chang CY. Peritendinous lesions: the role of high-resolution ultrasonography. Clin Imaging 2003; 27:239-50. [PMID: 12823919 DOI: 10.1016/s0899-7071(02)00545-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the peritendinous lesions over the extremities by high-resolution ultrasonography (HRUS). MATERIALS AND METHODS The authors retrospectively collected 328 cases, focusing on peritendinous lesions in limbs. The diagnosis was made by US findings with long-term follow-up, aspiration and biopsy proved. RESULTS The most common disease entity in our study is ganglion (n=270), followed by Baker's cyst (n=24). Other disease entities included tenosynovitis, bursitis, gout, hematoma, amyloidosis, thrombophlebitis, and other tumor/tumor-like lesions, such as osteogenic sarcoma (OGS), schwannoma, lymphoma, myxoid lipomsarcoma, xanthoma, intramuscular cavernous hemangioma, pigmented villonodular synovitis (PVNS), giant cell tumor of the tendon sheath (GCTTS), etc. CONCLUSION Because of dynamic capabilities and aid of real-time sono-guided fine needle aspiration, HRUS becomes an efficient and inexpensive tool for musculoskeletal lesions, especially in the superficial parts.
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Affiliation(s)
- Cheng-Feng Ho
- Department of Radiology, Catholic Cardinal Tien Hospital, Taipei, Taiwan, ROC
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15
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Griffith JF, Wong TYY, Wong SM, Wong MWN, Metreweli C. Sonography of plantar fibromatosis. AJR Am J Roentgenol 2002; 179:1167-72. [PMID: 12388493 DOI: 10.2214/ajr.179.5.1791167] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Plantar fibromatosis is a rare benign fibroproliferative disorder of the plantar fascia that can be evaluated on sonography. Our study details the sonographic appearances of plantar fibromatosis. MATERIALS AND METHODS We conducted a retrospective review of the clinical presentation, sonographic appearances, and clinical progress in 14 patients (range, 35-85 years; mean age, 53.1 years;) with plantar fibromatosis. Sonography was performed using either a 13-5-MHz multidimensional or 12.5-MHz linear array transducer. The location, sonographic appearances, and size of the plantar fibromatosis nodules were noted and correlated with symptom duration and clinical outcome. RESULTS A total of 25 fibromatosis nodules in 19 feet were examined. On sonography, plantar fibromatosis was seen as a discrete fusiform nodular thickening of the plantar fascia, separate from the calcaneal insertion. Approximately one third (36%) of lesions were bilateral, and one quarter (26%) were multiple. All lesions were located either medially (60%) or centrally (40%) in the fascia. Most were hypoechoic (76%), were well defined (64%), and showed no acoustic enhancement (80%) or intrinsic vascularity (92%). No correlation was found between the echogenicity and size of plantar fibromatosis nodules or duration of symptoms (p < 0.01). One quarter of the affected feet had coexistent thickening of the plantar fascia at the calcaneal insertion with no related symptoms. CONCLUSION Although the sonographic appearances of plantar fibromatosis vary, the appearances are characteristic enough to allow a specific diagnosis to be made. No clear relationship was found among the sonographic appearances, duration of symptoms, or clinical outcome.
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Affiliation(s)
- James F Griffith
- Department of Diagnostic Radiology and Organ Imaging, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Town, Hong Kong
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Abstract
Specimens from 13 patients with plantar fibromatosis were reviewed with particular attention to the presence and number of multinucleated giant cells in the lesions. These were found in all specimens but one and ranged from very few to many. The nuclei of the giant cells were uniform, rounded to somewhat elongated, and arranged in circles, semicircles, ovals, clusters, chains, and V's. Aside from the giant cells, the lesions were composed of the usual uniform fibroblastic spindle cells. The growth pattern was almost always multinodular, with nodules having moderate to high cellularity. Maximal mitotic rate varied up to more than 10 mitotic figures per 10 high-power fields but was most often between 1 and 4 mitotic figures per 10 high-power fields. The patients were from 10 to 66 years of age; nine were male and four were female. Two had bilateral involvement. Five patients had recurrence, including three with multiple recurrences, and all but one of the remainder had only short follow-up. Judging from the available data, recurrence did not appear to be related to any specific clinical or pathologic feature.
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Affiliation(s)
- Harry L Evans
- Division of Pathology, Department of Lymphoma, University of Texas-M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, U.S.A.
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Abstract
A retrospective study of 18 patients (23 feet) with plantar fibromatosis who required surgical excision between January, 1991, and June, 1998, was performed. Subtotal plantar fasciectomy was performed to remove the tumor with a wide disease-free margin. 16 patients (21 feet) were interviewed and 14 patients (19 feet) were examined with an average followup of 36 months. Two patients (2 feet) with less than 12 months followup were excluded. Both subjective and objective evaluations and pre- and postoperative x-rays were reviewed to assess the alignment of the bony arch. There were nine males and nine females, age 49 years, average, at the time of diagnosis. Sixty-seven percent of patients had bilateral disease, and 28% had associated Dupuytren's contracture. There were 18 primary and five recurrent tumors. An operative staging system, I to IV, for plantar fibromatosis is presented which incorporates the extent of plantar fascia involvement, the presence of skin adherence, and the depth of tumor extension. The stage of the tumor correlated well with postoperative wound healing, skin necrosis, and recurrence. In fifteen of 21 feet, the patients were satisfied without reservations, and in three of 21 feet, they were satisfied with reservations. In 18/21 (86%) feet, the patient reported he/she would have surgery done again. There were two recurrent tumors. One was reoperated and the patient was disease free twelve months postoperatively. The other recurrence was asymptomatic 40 months postoperatively and required no treatment. One patient required an excision of a postoperative cutaneous neuroma. Eleven of 21 feet (52%) experienced delayed healing and of which four required a split thickness skin graft. Ten of the eleven feet with delayed wound healing and all four cases requiring a skin graft had a stage ill or IV tumor. Pre- and postoperative weightbearing radiographs revealed a slight decrease in the calcaneal pitch angle, navicular height, and medial cuneiform height indicating a decrease in the height of the medial longitudinal arch.
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Affiliation(s)
- G J Sammarco
- Department of Orthopaedics, University of Cincinnati, School of Medicine, Ohio, USA.
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