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The hand
The fingers and thumb can be seen as rays coming from the carpal bones that make up the complicated joint of the wrist. In the fingers the rays are clearly separated, but in the palm, they are not, and the metacarpals, the bones in the palm, lie in the same mass of tissue.
There are three bones in each finger. Each bone is called a phalanx. The bone closest to the palm is the proximal phalanx, the next is the middle phalanx and furthest is the distal phalanx.
The joint between the metacarpal and the proximal phalanx is the knuckle or the metacarpophalangeal joint.
Each finger has two more joints. The proximal interphalangeal joint, or PIP, is the joint between the phalanges lying closest to the heart - that is, the joint between the proximal and middle phalanxes. The joint nearer the tip of the finger is the distal interphalangeal joint, or DIP.
Ligaments, tough sheets and cords of collagen, hold the wrist and hand together in a complicated, crisscrossing and overlapping web that resembles, perhaps, a nightmare intersection between 5 highways. Ligaments also hold the interphalangeal joints stable.
Tendons attach to the bone distal to each joint and merge into muscle, either in the palm or in the forearm. The nine long tendons that run from the fingers and palm to the forearm run through the narrow carpal tunnel. This is a passageway on the palmar side of the wrist that is comprised on the volar side by connective tissue and on the dorsal side by bones. Several tendons and the median nerve pass through it. The median nerve also runs through the carpal tunnel and can be compressed if any of the tendons become inflamed.
A long tendon emerges from the carpal tunnel and fans out, becoming a triangle - the strong, thick palmar aponeurosis, lying between the tendons and the skin. The aponeurosis, or fascia, is a tough, flexible sheet of closely packed bundles of collagen fibres organised along the lines of stress - mainly in the direction from wrist to finger.
The thumb side of the triangle is indistinct, merging into the muscles of the base of the thumb. At its broadest, level with the crook of the thumb, the triangle splits into four tough straps, or slips, one for each finger. The slips are attached to the skin of the palm, to the base of each finger, and to the sheaths of the tendons that flex the fingers.
The foot
The details of the anatomy of the foot are less important for understanding the disease, and the vocabulary used with Ledderhose is less extensive than the equivalent in the hand.
As in the hand, the foot is supported by thick connective tissue, the plantar fascia or aponeurosis. It is thickest and strongest in the arch of the sole. It starts at the back of the heel (the tuberosity of the calcaneus) and spreads out in a long triangle. At the head of the triangle, level with the beginning of the ball of the big toe, it splits into five thick straps that at their distal ends reach the furthest points of the metatarsal bones, where the bones of the toes begin.
Cells in the fascia called fibroblasts produce, maintain and dissolve the collagen fibres. If you’re reading this, this is the bit of the hand or foot that interests you most, since it is the bit that is involved in Dupuytren’s and Ledderhose disease.
The short answer is “probably not”; there is no uncontested evidence that diet has any impact on the disease.
Peer-reviewed papers reporting research on diet and superficial fibrotic diseases are as rare as hen’s teeth in the medical literature available on the Web of Science. On the topic of “Dupuytren Contracture” and nutrition, for example, the U.S. National Library of Medicine contains only seven references, none of which appear to pertain to a particular dietary lifestyle.
The absence of evidence has not stopped people touting the value of various dietary supplements. The highly profitable dietary supplement industry is largely unregulated, so avoidance of harm always be a consideration..
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Contact information provided below for radiation oncologists who have treated for Dupuytren's Contracture or Ledderhose . Comments or opinions expressed here or on DART are not intended to diagnose or prevent disease. Advice or comments should not be relied upon unless confirmed by your treating physician. No doctor-patient relationship is intended and members are advised to consult their doctors for medical advice. No representation is made about the quality or professional competency of the listed doctors. This listing provided as a place for you to begin your own research. If you find the contact info outdated or in error, please comment on DART where it can be corrected. You might also google the doctor or clinic to find updated contact information. Many of these doctors also practice at secondary locations that may be closer to you. Check their website. In addition to their clinical practice, many of these radoncs are also on the faculty of local medical schools where they teach radiation oncology. If you have doctor or clinic information not listed below, please share with DART so it can be made available to others looking for treatment in that location. some photos from dupuytrens.org Thank you.
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