CONTRACTIONS DEPENDENT UPON PATHOLOGICAL LESIONS IN THE CUTANEOUS AND FASCIAL STRUCTURES.
Lesions of the sole corresponding to Dupuytren’s disease in the hand are extremely rare, on account of the protection afforded by the shoe and the thickness of the plantar pad, and although cases have been mentioned by Mr. Adams and other surgeons, I believe none has yet been shown or discussed at any medical society. The following example deserves record:
The patient, a gardener, aged fifty-seven, was admitted to St. Thomas’s Hospital in May last with contraction of both hands. He stated that he first noticed a slight contraction beginning in the ring finger of the left hand twelve years ago; in the course of a year or two the disease extended to the little finger, and afterwards to the middle finger. Four years since a similar affection appeared in the right hand, and shortly before admission he observed a superficial nodule on the sole of each foot. He had never suffered from gout or rheumatism, and had always enjoyed good health; the family history was negative. On examination the third, fourth, and fifth fingers were found contracted in both hands; the fourth and fifth fingers of the left hand being strongly bent at the first and second joints, and brought into contact with the palm, while on the right side the lesions were similar in character but less advanced. In each sole a flat subcutaneous nodule could be felt adherent to the plantar fascia and slightly to the integument over the head of the second metatarsal bone, but there was no puckering of the skin, and the position of the toes was quite unaffected. The contracted cords in both hands were divided by multiple subcutaneous incisions, and the fingers were extended by plaster-of-Paris splints. The nodule upon the right sole was excised, and found to consist of white fibrous tissue, longitudinally striated, and adherent to the fascia, but could be detached from it without difficulty. Under the microscope the appearances presented were identical with those in the early stage of Dupuytren’s contraction, and there is no doubt that the foot nodule was pathologically the same as the contracted tissue in the hands. The operations upon the hands and feet were successful.