Quick answer
Ledderhose disease — also called plantar fibromatosis — is the formation of benign fibrous nodules within the plantar fascia (the strong band of tissue running along the bottom of the foot). Unlike a single, isolated plantar fibroma, Ledderhose disease tends to produce multiple nodules that may grow and progress over years. It’s the foot’s equivalent of Dupuytren’s contracture in the hand, and patients often have both. Despite the slow progression, the nodules are not cancerous.
How it differs from plantar fibroma
- Plantar fibroma — a single nodule. Often isolated and stable
- Ledderhose disease — multiple nodules, often progressive, sometimes leading to thickened bands within the fascia. The systemic-disease version of fibromatosis
The two are on a spectrum. A patient with one nodule may develop more over time, transitioning toward Ledderhose disease.
Why it develops
The exact cause is unknown, but Ledderhose disease shares biology with related fibrotic conditions:
- Dupuytren’s contracture (palm of hand) — present in 25–50% of Ledderhose patients
- Peyronie’s disease (penis)
- Knuckle pads
Risk factors include:
- Family history — strong genetic component
- Northern European ancestry — historically called “Viking disease”
- Male sex (about 2:1)
- Middle age
- Diabetes
- Alcohol use disorder
- Long-term seizure medications (phenytoin, phenobarbital)
- Trauma to the plantar fascia (debated as a trigger)
How to recognize it
- Firm lump in the arch of the foot — typically in the medial (inner) third, where the plantar fascia is thickest
- Painless at first, becoming tender as it grows or with shoe pressure
- Growth over months to years — often slow but persistent
- Multiple nodules in some cases, sometimes connected by thickened bands
- Discomfort with shoes, especially flat or thin-soled shoes that press the nodule against the ground
- Pain with walking on hard surfaces
- Often coexists with Dupuytren’s nodules in the hand
- No skin retraction typically (unlike Dupuytren’s, which often pulls the skin)
Diagnosis
- Physical exam — distinctive firm, fixed nodule within the plantar fascia
- Ultrasound — confirms the nodule is within the plantar fascia (rather than in skin or deep tissue) and assesses size
- MRI — sometimes used for atypical lesions or surgical planning. Helps rule out other masses
- Biopsy — rarely needed if imaging is consistent. Avoid excisional biopsy unless clearly indicated, because surgery in this region tends to provoke regrowth
- Family history — ask about Dupuytren’s, Peyronie’s, family fibromatosis
Treatment
The goals: relieve symptoms, slow progression where possible, avoid unnecessary surgery (which often triggers regrowth).
Conservative care (first-line)
- Soft, padded orthotics with cutouts under the nodule — the most common approach. Reduces shoe pressure and walking pain
- Wide, soft shoes — avoid stiff or thin-soled shoes
- Activity modification — limit prolonged standing on hard surfaces during flares
- NSAIDs for inflammation flares
- Stretching of the plantar fascia and calf
Injections and minimally invasive options
- Cortisone injection into or around the nodule — can soften it and reduce pain. Risk of fat pad atrophy with repeated use
- Verapamil topical gel — anecdotal benefit; modest evidence
- Collagenase injections — used for Dupuytren’s; emerging data for Ledderhose
Radiation therapy
- Low-dose radiation is used in some centers, particularly in Europe, for early disease to slow progression. Limited availability in the US
Surgery
Reserved for symptomatic cases that fail conservative care:
- Wide local excision (subtotal or total fasciectomy) — removal of the involved fascia. Smaller, isolated nodules can have wide excision with low recurrence. Diffuse Ledderhose disease has high recurrence rates (up to 60%)
- Recovery — typically several weeks of restricted weight-bearing; full recovery 2–4 months
- Risks — recurrence, nerve injury, wound healing problems
The dilemma: surgery often causes the disease to recur more aggressively. Most surgeons reserve it for refractory, severely symptomatic cases.
Bottom line
Ledderhose disease is a benign but persistent condition. The mainstay of treatment is soft orthotics with cutouts and shoe modifications. Surgery should be reserved for refractory cases because it often provokes recurrence. Patients should be told the diagnosis is not cancer but is chronic — most live with the nodules long-term, with periodic flares managed conservatively. Look for associated Dupuytren’s contracture in the hand, since the two conditions often coexist and the family history is shared.
Frequently asked questions
What is Ledderhose disease?
Ledderhose disease (also called plantar fibromatosis) is a benign condition in which firm, fibrous nodules form within the plantar fascia — the thick band of tissue running along the bottom of the foot. The nodules are made of the same kind of tissue as the cords found in Dupuytren's contracture in the hand, and the two conditions often coexist in the same person. Ledderhose nodules grow slowly over months to years and most commonly appear in the inner arch of the foot. It's named after German surgeon Georg Ledderhose, who described the condition in 1894.
Is Ledderhose disease the same as Dupuytren's disease in the feet?
Essentially yes — Ledderhose disease is what we call Dupuytren's of the feet. Dupuytren's contracture in the hand and Ledderhose disease in the foot are both forms of superficial fibromatosis: the same underlying tissue process, just in different body locations. About 25 to 50 percent of patients with Ledderhose also have Dupuytren's in the hand, and a smaller percentage have Peyronie's disease as well. The three together are sometimes called the 'Dupuytren's diathesis.' Treatment principles overlap, though the foot has its own challenges because of weight-bearing pressure.
Why is Ledderhose disease called Viking disease?
The 'Viking disease' nickname reflects the condition's strong association with people of Northern European descent — particularly those with Scandinavian, British, Irish, or northern German ancestry. The same name is used for Dupuytren's contracture in the hand, and the historical theory is that the underlying genetic predisposition spread with Viking migrations from Scandinavia across Northern Europe and the British Isles a thousand years ago. The condition is much less common in people of African, Asian, or Hispanic descent, supporting the genetic story. The name is colloquial rather than medical, but it's widely used by patients and in popular health writing.
What does Ledderhose disease look and feel like?
The classic finding is one or more firm, well-defined lumps in the arch of the foot, usually on the inside (medial) third. The lumps feel hard and fixed — they don't move easily when you press on them, because they're embedded in the tough plantar fascia tissue. They typically start painless and become tender only when they grow large enough to press against the shoe sole or interfere with walking. Unlike Dupuytren's in the hand, Ledderhose nodules do not usually pull the toes down the way Dupuytren's pulls the fingers in — the foot's anatomy is different. Multiple nodules may be linked by thickened fibrous bands.
What shoes are best for Ledderhose disease?
The single most important footwear feature is a wide, soft toe box and a cushioned sole with arch contouring that does not press directly on the nodule. Practical guidance: avoid thin, flat, or stiff-soled shoes (minimalist running shoes, dress flats, hard-soled work boots) that transmit pressure straight through to the nodule. Look for shoes with extra cushioning (Hoka, New Balance Fresh Foam, Brooks Glycerin) and consider custom orthotics with a cutout directly under the nodule — these redirect pressure around the lump rather than through it. Some patients find memory foam insoles helpful. Heel lifts can shift weight forward away from a midfoot nodule. The exact best shoe depends on where the nodule sits, which is why a podiatry visit pays off.
Will Ledderhose disease go away on its own?
Generally no — Ledderhose nodules are persistent. They rarely spontaneously regress, and the natural history is slow growth over years with periodic flares. The good news: the condition is benign, and many patients live comfortably with the nodules indefinitely using padded inserts and shoe modifications. The bad news: surgical removal often triggers more aggressive recurrence (recurrence rates up to 60% for diffuse cases), which is why most surgeons reserve surgery for severely symptomatic cases that have failed conservative care. The realistic goal is symptom management, not cure.
Can Ledderhose disease turn into cancer?
No. Ledderhose disease is a benign (non-cancerous) fibrous proliferation. The tissue does not transform into a malignant tumor, and patients with Ledderhose do not have an elevated risk of foot or skin cancers. The cells are fibroblasts (the cells that make connective tissue) that are simply proliferating in an organized but disordered way. If a foot lump grows unusually fast, is painful out of proportion, or has irregular features on imaging, a biopsy may be done to rule out other diagnoses — but pure Ledderhose disease is safely benign.
What treatments work for Ledderhose disease?
First-line treatment is conservative: soft custom or over-the-counter orthotics with cutouts under the nodule, wide and well-cushioned shoes, calf and plantar fascia stretching, and short courses of NSAIDs for flares. For symptomatic cases that don't respond, options include corticosteroid injection (can soften the nodule and reduce pain — limited to a few injections per area), collagenase injections (emerging from Dupuytren's research), and low-dose radiation therapy (used more in Europe than the US, with evidence for slowing progression in early disease). Surgical excision is a last resort because of the high recurrence rate — most surgeons reserve it for patients with severe pain not controlled by anything else.
Sources
Last updated: May 16, 2026
About the author
Written and reviewed by a Doctor of Podiatric Medicine (DPM) practicing in Arizona for 6+ years. Board-certified by the American Board of Podiatric Medicine (ABPM); graduate of Midwestern University Arizona College of Podiatric Medicine.
Last clinically reviewed: May 16, 2026