What is Plantar Fibromatosis?
Plantar fascial fibromatosis, (aka Ledderhose's disease) is a thickening of the deep connective tissue, or fascia, on the bottom of the foot. A similar process can occur in the hands, and is called Duputren’s disease. It is a minor and relatively uncommon condition, and is important to know that it is non-malignant. Although it is typically not progressive in nature, it can be very painful.
A plantar fibroma begins with a nodule that grows along the plantar fascia on the bottom of the foot. The skin over top of the fibroma moves freely. Typically the fibroma grows slowly over time and is found in the central and medial portions of the plantar fascia. As the lump thickens, it causes stiffness and pain with walking. It is not uncommon for the nodules to change shape or size periodically throughout life.
The exact origin of the disease is currently unknown, although some researchers speculate that a plantar fibroma is caused from the body’s over aggressive healing response to small tears in the plantar fascia following an injury.
Certain risk factors have been identified and include:
- A family history of the disease
- Higher incidence in males
- Fibromatosis in the palms, 10-65% of the time
- Peyronie’s disease
- Epilepsy patients
- Diabetic patients
How are plantar fibromas diagnosed?
To diagnose a plantar fibroma, a podiatrist will examine the foot and press on the affected area. Other testing such as MRI and diagnostic ultrasound are effective in showing the location and size of the fibroma, but to know the exact tissue composition a biopsy must be performed.
How is plantar fibromatosis treated?
The goal of non-surgical treatment is to help relieve the pain from a plantar fibroma, however it will not make the mass disappear. Multiple options can be used to reach this goal, including:
- Steroid injections. Injecting corticosteroid medication into the mass may help shrink it and thereby relieve the pain that occurs when walking. This reduction may be only temporary and the fibroma could slowly return to its original size.
- Orthotic devices. If the fibroma is stable and remains a constant size and shape, custom orthotic device or specific padding may relieve the pain by distributing weight away from the fibroma.
- Physical therapy. Other methods in physical therapy can be used to deliver anti-inflammatory medication into the fibroma without the need for an injection.
If the fibroma becomes larger or more painful despite conservative measures, surgical intervention can be done to remove the mass. Unfortunately, plantar fibromas have a high incidence of recurrence. It is important to note that an operation for a plantar fibroma is difficult due to the location of tendons, nerves, and muscles in this area of the foot. Also, because the plantar fascia is important in carrying the weight of the body, this surgery may weaken the arch and could cause it to flatten.
Do you have questions about pain in the bottom of your feet? If you live in the Berkley, Southfield, Royal Oak, Oak Park or Ferndale areas give NorthPointe Foot & Ankle a call at (248) 545-0100 or schedule an appointment online.