Plantar Fibromatosis (Ledderhose Disease)

Resumen para el Paciente

¿Está esto autorizado por FDA para este uso?

Not FDA-cleared for plantar fibromatosis. FDA cleared medicinal leeches only for venous congestion in microsurgical reconstruction (K040187, June 2004). Use for Ledderhose disease is investigational.

¿Qué evidencia existe?

Tier C (investigational). One small case series (n=10) reports symptomatic pain reduction and nodule softening at 16 weeks; there are no randomized controlled trials. Established options for symptomatic plantar fibromatosis include custom orthotic accommodation (first-line), low-dose radiotherapy for early disease, and surgical excision for advanced disease (with high recurrence rates and risk of plantar nerve injury). Most asymptomatic nodules require only observation.

Riesgos principales

• Bleeding from bite sites for 6 to 24 hours after detachment
• Bruising and tenderness on the plantar surface
• Local skin infection or, rarely, Aeromonas infection
• Allergic reaction to leech saliva (uncommon)
• Worsening pain after the procedure (transient)
• Risk if a leech is placed too close to a plantar nerve or rupture site
• Difficulty bearing weight for several days after treatment
• Delay of orthotic accommodation, radiotherapy, or surgical evaluation

Quién no debería considerar esto

• Patients with active plantar fascial rupture or ulceration
• Patients with diabetic peripheral neuropathy (reduced protective sensation at bite site)
• Patients with peripheral arterial disease severe stenosis (ABI <0.6)
• Patients on anticoagulants, with hemophilia, or with severe anemia
• Pregnant patients
• Patients who have not tried custom orthotic accommodation

Qué preguntar a su clínico

• Have I tried custom orthotic accommodation and activity modification?
• Have I been evaluated for low-dose radiotherapy in early-stage disease?
• Is my diabetic foot exam normal (sensation, pulses, ABI)?
• What evidence specifically supports leech therapy for plantar fibromatosis?
• Are leeches from an FDA-registered supplier and used only once?
• What is the practitioner's Aeromonas-prevention plan?
• What is the cost and is it covered by insurance? (typically not covered)

Cuándo buscar atención urgente

• Inability to bear weight or new severe foot pain after treatment
• Numbness or tingling in the foot (possible nerve injury)
• Spreading redness, warmth, pus, or red streaks (cellulitis)
• Fever above 38.0 C / 100.4 F or chills
• Bleeding from a bite site lasting more than 24 hours
• Hives, facial or tongue swelling, throat tightness, or breathing difficulty