# Combination Hyaluronidase and Triamcinolone Acetonide Enzymatic Injections for Treatment of Ledderhose Disease: A Novel Technique and Case Series

## TL;DR

A new injection technique combining hyaluronidase and triamcinolone acetonide effectively reduces pain and fibromas in patients with Ledderhose Disease.

## Contribution

This is the first study to explore hyaluronidase in combination with triamcinolone acetonide for treating Ledderhose Disease.

## Key findings

- Three patients experienced significant reduction or elimination of nodules and pain within six weeks of treatment.
- Patients remained asymptomatic at two years following the injections.
- The combination therapy was more effective than triamcinolone acetonide alone in reducing fibromas and pain.

## Abstract

Background: Ledderhose Disease, or plantar fibromatosis, is a fibroproliferative disorder affecting the plantar fascia with limited effective treatment options. Although hyaluronidase has a long history of clinical use, it has not been previously used for Ledderhose Disease. This study explores the use of combined hyaluronidase and triamcinolone acetonide enzymatic injections as a novel and promising technique for managing Ledderhose Disease. Methods: This paper investigates the use of combination therapy with hyaluronidase, triamcinolone acetonide, and lidocaine injections in three patients with Ledderhose Disease. Injection protocols, dosage, frequency, and patient outcomes are all discussed. Additionally, this study explores the underlying mechanisms of hyaluronidase action in Ledderhose Disease, shedding light on its potential to modulate fibrotic tissue and alleviate symptoms. Results: All three patients treated with a series of hyaluronidase, triamcinolone acetonide, and lidocaine anesthetic injections experienced either a significant reduction in or elimination of nodules and associated pain within 6 weeks after initial injection. Patients were asymptomatic at two years follow-up after injections. Conclusions: The combination of hyaluronidase and triamcinolone acetonide injections significantly decreased pain and softened fibromas faster than triamcinolone acetonide injection alone, as explored in previous studies. Large prospective studies are needed to further compare enzymatic injection therapies in the management of Ledderhose Disease.