Plantar Fibromatosis (Ledderhose Disease)

Common Symptoms

• A firm, sometimes tender nodule or nodules in the arch of the foot
• Pain with standing, walking, or direct pressure on the nodule
• Nodules that can gradually grow over months to years
• In more advanced cases, associated tightening that can affect toe positioning, though this is less common than in Dupuytren's contracture of the hand

Why It Happens

Like Dupuytren's contracture, the exact cause isn't fully understood, but it involves an overgrowth of the connective tissue (plantar fascia) in the sole of the foot, with genetics playing a meaningful role — it's more common in people with a family history of Dupuytren's contracture.

Why It Can Become Persistent

Once nodules have formed, they generally don't resolve on their own and can continue to grow gradually over time, which is a structural, tissue-level change rather than something that responds to rest alone.

Who Commonly Gets It

Plantar fibromatosis is more common in men, often develops in middle age, and is associated with a personal or family history of Dupuytren's contracture, diabetes, and certain other conditions.

How It Is Usually Diagnosed

Diagnosis is usually clinical, based on the characteristic firm nodule in the arch of the foot; ultrasound or MRI can help confirm the diagnosis and distinguish it from other causes of a foot mass if there's any uncertainty.

Traditional Treatment Options

• Padding and offloading footwear: Reducing direct pressure on the nodule is a foundational first step.
• Custom orthotics: Can help redistribute pressure away from the affected area.
• Corticosteroid injection: Sometimes used for symptomatic relief.
• Surgical excision: Carries a meaningfully high risk of recurrence, often used only for significant, functionally limiting cases.

Why Someone Might Start Looking for Another Option

Because surgery for this condition carries a real recurrence risk, there's clinical interest in non-invasive options that might help with pain, including shockwave therapy.

Where Shockwave Therapy May Fit

The evidence here is small and early: a short report of 6 patients found meaningful pain reduction and nodule softening after high-energy focused shockwave therapy, sustained to 3 months, and a separate case report of a patient with bilateral disease found substantial pain reduction and improved foot function over 2 months, with ultrasound showing more uniform tissue texture, though without a reduction in nodule size. We want to be direct that this tops out at small case series and case reports — there are no controlled trials for this specific condition, similar to the early-stage evidence on our Dupuytren's contracture page.

How Shockwave Treatment Works for This Area

If considered appropriate, acoustic pressure waves would be applied directly to the nodule, generally alongside padding and offloading strategies.

What the Treatment Feels Like

Most patients describe a firm tapping or pressure sensation directly over the nodule, which can be tender given the weight-bearing location; your provider will discuss what to expect.

What Happens During Your First Visit

Your visit begins with a provider evaluation focused on your history and a physical exam relevant to your complaint. If shockwave therapy is determined to be clinically appropriate, your first treatment can typically be provided the same visit. See our What to Expect page for the full walkthrough.

Who May Not Be Appropriate

• Anyone who has not yet had a medical evaluation to confirm the diagnosis
• Active infection, open wounds, or certain bone conditions at the treatment site

This list is not exhaustive. Your provider will screen for contraindications during your evaluation.