A 44-year-old man with no significant medical history presented with an 8-year history of painless plantar nodule of the right foot. In the previous 6 months the patient felt discomfort while walking. On examination, he had subcutaneous nodules on the medial aspect of the plantar surface of the right foot. There was no family history of similar nodules. The patient was not taking any medication and was otherwise healthy. Vital signs and laboratory tests were normal.\nAn ultrasound () of the plantar arch was made using 13–5 MHz array transducer and showed a hypoechoic and homogeneous nodule of the plantar fascia with increased color Doppler flow. MRI of the foot confirmed the ultrasound data, showing a hyperintense nodule on proton density images () which was hypointense on T1-weighted images (), at the distal part of the superficial medial plantar fascia. The lesion was intensely enhanced after injection of Gadolinium ().\nThe diagnosis of Ledderhose disease was suspected based on the clinical-radiographic data. However, because of the flow inside the lesion at color Doppler, a biopsy was performed to rule out malignancies. Histological examination () of the nodule demonstrated increased fibroblastic activity and a reduction of the collagen network. Our patient received conservative treatment with anti-inflammatory drugs, physiotherapy, and orthotic support with satisfactory evolution.
A 30-year-old man presented painful bilateral plantar nodules. Physical examination showed multiple and bilateral fixed and solid nodules measuring 1 cm each on the plantar and medial side of his feet (\n). Five years earlier, the first painless nodule appeared in his right foot, and the number of nodules increased and become painful over the following years. He had using orthopedic insoles for the last 6 months. He was not taking any medication, and there was no family history of those nodules. Routine laboratory tests and blood glucose levels were normal. He did not have Dupuytren disease, diabetes mellitus, alcohol addiction, penile fibromatosis, epilepsy, or frozen shoulder. Ultrasound was performed, and hypoechoic homogeneous nodules were detected. The patient underwent surgery, and the nodes were removed via a plantar incision with 2-cm safety distance (\n). There was no skin or muscle infiltration. The skin was closured primarily, wound dressing was changed once a day, and touching the ground was banned for 1 day. We continue to follow the patient (\n).