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The possible source material for Captain Hook’s hook – Dupuytren’s Contracture

People come to Happy Feet Pedorthics usually knowing their diagnosis. Some have researched so much they have almost self-diagnosed or certainly come to understand much more than they believed they had been told at diagnosis. This type of client is often surprised when we recognise symptoms of a condition because “their doctor didn’t know much, or didn’t recognise.”

Dupuytren’s Contracture is a shortening and thickening of the palm’s tissue that results in the clawing of the fingers. The cause is unknown but it may have a hereditary component. Related risk factors include alcoholism, epilepsy and diabetes, gout, rheumatism, injury and infection. Treatments can range from occupational therapies to surgery.

In doing some further research in preparing for this blog there are some related conditions where other parts of the body may be affected in a similar way to Dupuytren’s Contracture

  • Ledderhose’s disease – which creates a thickening and shortening of the foot’s connective tissue, which as it progresses can create severe pain when walking
  • Peyronie’s Disease – where there may be a thickening and shortening of tissue in the penis
  • Garrod’s pads – where the finger joints on the same hand affected by the Dupuytren’s Contracture may enlarge and thicken

The name Dupuytren has a few references in history

  • Guillaume Dupuytren (1777-1835) was Napoleon’s surgeon and the most famous surgeon in France at the time. In 1831 he performed surgery and then lectured on a condition causing bent fingers. Since this then the condition has carried his name. However Dupuytren was not the first to describe the condition
  • Dupuytren disease has been referred to as a Viking or Celtic disease; however it existed in Europe earlier than the Viking Age and originated much earlier in prehistory.
  • James Barrie, author of “Peter Pan” had a right contracture thought to be Dupuytren’s, which formed the source material for Captain Hook’s hook.
  • The Papal Benediction sign, with bent ring and small fingers, may have started with a pope with the condition

People with Ledderhose disease, Dupuytren’s contracture of the foot often talk about a lump in the arch of the foot and pain with weight-bearing.
The pedorthic applications for Ledderhose disease, Dupuytren’s contracture of the foot can include:

  • Well fitted depth shoes
  • Full steel shank to prevent extension of the toes and exposure of the plantar aponeurosis
  • Rigid rocker soles – often times a double rocker to reduces ground reaction forces in the mid foot region
  • Excavations to the shoe
  • Medial sole and heel wedges
  • Thomas heels dependent on where the fibroma is present
  • A combination of functional and accommodative orthosis
  • Referral on through the General Practitioner

Clare Nelson C Ped CM AU