Dr. Greene's Answer
In the palms of our hands and the soles of our feet, we each have a tough fibrous layer called fascia (the palmar fascia and plantar fascia, respectively). In Dupuytren’s contracture (pronounced du-pwe-trahns), one or both of these fibrous layers begins to grow awry. In palmar fibromatosis (“classic” Dupuytren’s contracture), the palmar fascia slowly begins to thicken, and then shorten. The fingers are relentlessly drawn inward into a rigid, misbegotten fist. As flexibility slips away, so does the useful functioning of the hand. In plantar fibromatosis, this same relentless shortening happens in the soles of the feet, drawing the toes downward, folding the feet into a frozen fist, and making it impossible to walk. The foot version is much less common. Either way, untreated Dupuytren’s contracture can be a crippling disease.
Dupuytren’s contracture was first described by Baron Guillaume Dupuytren, a celebrated French surgeon of the early 1800’s who was apparently successful with the surgical treatment of this condition. By carefully cutting the involved fascia he was able to achieve good results — for a while. Whatever had caused the fascia to grow incorrectly before, caused the regrowing fascia to eventually shorten and thicken as well. Thus, for over 100 years the condition was thought to be relentlessly progressive. We now know that it can follow many courses, from quite mild to very severe. There are also more effective treatment options than ever before, and there is real reason to have hope.
Dupuytren’s contracture is a genetic condition that is passed as a dominant trait with “variable penetrance.” This means that, if it runs on your side of the family, it is present in someone in every generation, although it may be so mild as to go unnoticed.
Note: We received a helpful letter from a reader here at drgreene.com who wished to pass on some information about a new minimally invasive surgery for Dupuytren’s Contracture. This is not a pediatric surgery, however if you are interested you can learn more about the surgery at www.dupuytrenscenter.com.