Dupuytren contracture and Ledderhose disease

Dupuytren disease is a fibroproliferative disorder of the palmar fascia in which myofibroblasts deposit collagen, forming nodules and cords that progressively tether and contract the fingers (most often the ring and little fingers). Ledderhose disease is the equivalent process in the plantar fascia of the foot. In the early, proliferative stage the nodules are cellular and growing; once mature cords form and joints contract, the fibrosis is fixed.

Low-dose radiation inhibits the proliferation and differentiation of the active myofibroblasts in the proliferative phase, reducing further collagen deposition. It does not dissolve existing nodules or cords — the goal is to arrest progression so the patient never needs surgery, needle aponeurotomy, or collagenase injection. The strongest experience comes from long-term European series, which US centers increasingly adopt.

The hand (or foot) is positioned flat and reproducible, often using a custom cast or a simple foam support with the affected palm facing up. The nodules and cords are palpated and outlined with a radiopaque wire or lead markers, and the field is drawn with a two-centimeter margin around the marked disease. No CT simulation is required for most patients — kilovoltage or electron planning on a simulator image is sufficient. The fingers are positioned so unaffected rays are shielded or excluded from the field.

The classic regimen is 21 Gy total: seven fractions of 3 Gy delivered twice weekly over five to seven weeks, split by a six- to eight-week rest after the first three fractions (30 Gy in some centers uses a similar split course). Treatment uses low-energy electrons (typically 6–12 MeV) or orthovoltage photons with bolus, and each fraction takes minutes. Patients are assessed at three to six months and yearly thereafter, with progression-free rates of 70–85% reported in long-term series.