Plantar fibromatosis is a rare medical disorder marked by the growth of benign tumors under the
foot. These tumor-like nodules, known as plantar fibromas, are noncancerous and do not pose a serious health threat, though they may cause discomfort. They develop on the underside of the foot, or plantar surface. The heel is connected to the bottom of the foot by a band of connective tissue called the plantar fascia. The superficial plantar aponeurosis is the fibrous tissue where these nodules typically develop, and the outermost layer of the entire plantar fascia. The tumors grow slowly and are made up of excess collagen. During disease progression, increased collagen production occurs, especially in the early stages.
The condition may affect both feet (Ledderhose’s disease) and is not likely to resolve on its own. Ledderhose’s disease shares clinical and pathological features with Dupuytren disease, including similarities in disease mechanisms and treatment approaches. It affects males more than females and is relatively common among Caucasian individuals. Plantar fibromatosis is more prevalent in men, especially those older than 70, and is associated with risk factors such as diabetes, genetics, and familial patterns.
Overview
Causes
The exact cause of plantar fibromatosis is unknown, but several factors are associated with its development, including:
- Damage to the plantar fascia
- Age – greater risk in people 50 and older, with the highest incidence in men above 70
- Prolonged use of anti-seizure medications
- Congenital factors
- Genetic predisposition, such as specific genetic variants
- Diabetes mellitus
- Alcohol consumption
- Liver dysfunction
- Epilepsy
- Thyroid dysfunction
- Standing for extended periods
- Excessive intake of vitamin C
Symptoms
- Pain and discomfort while walking
- Difficulty bending the toes as the tumors grow
- A prominent, firm lump near the foot arch
- Multiple fibromas or nodules
- Discomfort while wearing shoes
- Pain during barefoot movement
Diagnosis
- Review of the patient’s medical and family history
- Evaluation of all current and past medications
- Detailed examination of the existing condition and symptoms
- Differential diagnosis to distinguish plantar fibromatosis from other foot arch masses
- X-ray imaging as needed
- MRI or CT scan to assess soft tissues and identify the exact location, size, and shape of the tumor
- Imaging, including ultrasound and MRI, helps evaluate plantar fibromatosis and differentiate it from other pathologies
Treatment
Medical treatments for plantar fibromatosis include both conservative therapies and surgical options.
- If the tumor is small and does not interfere with daily activities, treatment focuses on alleviating pressure on the foot.
- Orthotic devices, such as pads, night splints, or shoe inserts that support the arch, may be used.
- Reducing pressure can help shrink the tumor.
- Medicated gel may help reduce the size of fibromas. Calcium channel blocker medications, such as verapamil, can be applied as a transdermal cream or injection to inhibit collagen production.
- Cortisone injections may help in some cases. Imaging-guided injections can improve precision and outcomes.
- Surgical removal of fibromas may be necessary for persistent or large tumors.
- The tumors grow slowly; the proliferative phase is marked by increased fibroblast activity and cell proliferation.
- Use of crutches for a few weeks post-surgery may be recommended. Managing weight-bearing during recovery is important for proper healing.
- Maintaining a healthy body weight, wearing comfortable shoes, staying hydrated, and regular stretching exercises may help prevent recurrence.
- Avoid standing for long periods or walking on hard surfaces to reduce pressure on the foot.
- If pain continues after nonsurgical treatment, surgical intervention may be considered.
Understanding Plantar Fibromatosis
Plantar fibromatosis, also known as Ledderhose’s disease, is a benign but locally aggressive condition that affects the plantar fascia—the thick band of connective tissue running along the bottom of the foot from the heel to the toes. This disorder leads to the formation of firm, fibrous nodules within the plantar fascia, often around the foot arch. While these growths are noncancerous, they can cause significant pain, especially when standing or walking, and may interfere with daily activities. The presence of plantar fibromas can make the bottom of the foot feel tender and may limit mobility, making it difficult to wear shoes comfortably. Understanding the causes, symptoms, and available treatment options for plantar fibromatosis is essential for managing pain and maintaining foot health.
Causes and Risk Factors
Although the exact cause of plantar fibromatosis remains unclear, several risk factors may increase the likelihood of developing this condition. A genetic predisposition appears to play a significant role, as individuals with a family history of plantar fibromatosis or related conditions, such as Dupuytren’s disease, are at higher risk. Foot trauma, including repetitive stress or injury to the plantar fascia, can also contribute to the development of fibrous nodules. Certain medical conditions, such as diabetes and epilepsy, are associated with a higher incidence of plantar fibromatosis. The condition is more common in middle-aged patients, particularly those of Northern European descent. Additional risk factors include wearing shoes that are too tight or lack proper support, standing for long periods, and having a family history of similar soft tissue disorders. Recognizing these risk factors can help patients and healthcare providers take proactive steps to manage and potentially prevent progression of the disease.
Symptoms and Diagnosis
Plantar fibromatosis typically presents as a noticeable lump or nodular mass in the arch of the foot, which may gradually increase in size. Patients often experience pain or discomfort, especially when walking, standing barefoot, or wearing shoes that press against the affected area. As the condition progresses, soft tissue swelling and chronic pain can develop, sometimes making it difficult to move the toes or bear weight on the foot. In some cases, multiple lesions may form, further complicating mobility and shoe wear.
Diagnosis begins with a physical exam and a review of the patient’s medical and family history. A healthcare provider may palpate the foot to assess the size, location, and consistency of the lump. Imaging techniques such as magnetic resonance imaging (MRI) are often used to evaluate soft tissue involvement and distinguish plantar fibromatosis from other conditions like a ganglion cyst or tendon sheath tumor. MRI findings typically show low signal intensity masses within the plantar aponeurosis. In certain cases, a biopsy may be performed to confirm the diagnosis and rule out other soft tissue masses. Early and accurate diagnosis is crucial for guiding treatment and reducing pain.
Non-Surgical Treatments
For many patients, non-surgical treatments are the preferred initial approach to managing plantar fibromatosis.
Physical therapy plays a key role, with stretching exercises and calf muscle strengthening designed to improve flexibility and reduce pain in the plantar fascia. These exercises can help maintain mobility and decrease tension on the affected tissue. Steroid injections are another common non-surgical treatment option, as they can help reduce inflammation and provide temporary pain relief. Orthotic devices, such as custom shoe inserts or arch supports, are often recommended to redistribute pressure away from the nodular mass and support the foot arch, making walking and standing more comfortable. A healthcare provider may also suggest nonsteroidal anti-inflammatory drugs (NSAIDs) or other medications to manage pain and soft tissue swelling. By combining these non-surgical options, many patients can reduce pain and maintain an active lifestyle without surgery.
Surgical Options
When non-surgical treatments fail to provide adequate relief or if plantar fibromatosis becomes severe, surgical treatment may be considered. The most common procedure is surgical excision, which involves removing the fibrous knot and affected portions of the plantar fascia. In more advanced cases, a partial or complete plantar fasciectomy may be necessary to address extensive involvement. Surgical intervention aims to relieve pain, restore function, and prevent recurrence, but it is not without risks such as wound-healing complications or new fibroma development. A healthcare provider will carefully evaluate the patient’s overall health, disease extent, and response to previous treatment before recommending surgery. Postoperative care often includes physical therapy and activity modification to support recovery and reduce recurrence risk. Surgery remains an important option for patients with persistent pain and limited function due to plantar fibromatosis.
Your path to recovery starts here. Call OrthoTexas today to schedule an appointment with our foot and ankle specialists for comprehensive plantar fibromatosis treatment. Book your appointment online or call (972) 492-1334.
