Plantar Fibromatosis

Plantar Fibromatosis is a foot condition where a small nodule grows in the arch of the foot on the plantar fascia.  It is a benign growth (i.e. non-cancerous) which tends to be slow growing and usually less than an inch in size. 

It is often painless, but depending on the location and size of the nodules it can start to cause foot arch pain when you are on your feet.

Other medical terms for plantar fibromatosis include Ledderhose Disease, after Georg Ledderhose who first identified the disease in 1894, Morbus Ledderhose and Plantar Fascial Fibromatosis.  It is a similar condition to Dupytren’s contracture which occurs in the hand causing flexion of the fingers. 

Here, we will look at the common symptoms and causes of plantar fibromatosis, how it is diagnosed, treatment options and how to reduce the rate of recurrence.

What Is Plantar Fibromatosis?

Quick anatomy lesson.  On the bottom of the foot, is a thick band of fibrous tissue, known as the plantar fascia.  It runs between the heel and the toes, helping to support the arches of the foot.

In plantar fibromatosis, thickenings develop in the plantar fascia forming small nodules, usually in the central or medial portions of the plantar fascia.  There may be one solitary nodule or a cluster of nodules may develop. 

Ledderhose Disease is a relatively minor condition but can cause pain with weight bearing activities such as standing and walking.   It usually only affects one foot, but in 25% of cases, both feet are affected.  It should not be confused with plantar fasciitis where there is inflammation and degeneration of the plantar fascia.

Common Symptoms

Plantar fibromatosis may go undetected for years if it is not causing any pain.  Symptoms include:

Plantar Fibromatosis is characterised by a small lump underneath the foot

1)  Visible Nodule: The most common symptom is a small lump under the skin on the sole of the foot.  The nodules tend to be on the inner side of the sole of the foot, at the highest point of the foot arch.   They are relatively small in size, usually measuring less than one inch and feel firm to touch.  They may remain the same size, grow over time or more nodules may gradually appear forming a cluster.  The nodules can most easily be seen by dorsiflexing the foot – pulling the toes up.  The growths remain permanently unless removed surgically, they don’t just spontaneously resolve

2)  Pain:  Often plantar fibromatosis is entirely painless, but as the lump grows it may start to cause problems.  Pain tends to occur when there is pressure directly on the nodule, either from prodding it, pressure from shoes or weight bearing through the foot when standing, walking or running

3)  Toe Stiffness:  As the condition progresses, it can cause thickening of the plantar fascia.  This can result in contractures which cause the toes to bend, limiting toe movements, causing stiffness and making walking difficult

Possible Causes

The underlying cause of plantar fibromatosis is unknown but there are a number of factors which are thought to be linked with the disease:

1)  Genetics:  A family history of Ledderhose Disease is the strongest risk factor
2)  Gender: The condition is more common in men with a male:female ratio of 2:1
3)  Medical Conditions:  Diabetes, epilepsy, liver disease and Peyronie’s disease are thought to be associated with increased risk of developing plantar fibroma
4)  Long-term Alcohol Consumption: is thought to increase the risk of developing Ledderhose Disease
5)  Repetitive Foot Trauma:  it is thought that plantar fibromatosis may develop as a result of small tears in the plantar fascia.  As the body tries to heal itself, it goes into overdrive, laying down too much new tissue which forms the nodules

Diagnosing Ledderhose Disease

Your doctor may be able to diagnose plantar fibromatosis through clinical examination.  If there is any doubt, an MRI scan (Magnetic Resonance Imaging) is usually the imaging of choice as there are other conditions than present in a similar fashion.  It tends to be more accurate than x-ray or ultrasound, showing the full extent of the condition. 

Treatment Options

Treatment for plantar fascial fibromatosis usually falls in to three categories:

1)  Observation

Asymptomatic nodules, i.e. those that aren’t causing any pain will most likely just be monitored.  The nodules will never disappear, but they may remain unproblematic

2)  Non-Surgical Treatment

If the nodules are causing pain, there are a few conservative options that can help:

a)  Injections:  Corticosteroid injections can help relieve the pain and reduce the size of the growth but the effects are often short lived.  It is most effective in the early stages of the disease
b)  Orthotics:  Wearing shoe insoles or special padding can help to reduce the force through the nodules, making walking more comfortable
c)  Physiotherapy:  Treatment such as stretching exercises, ultrasound and shock wave therapy may help

3)  Surgical Treatment

Surgery should only be considered with prolonged high pain levels and resultant decreased activity levels over a number of months.  This is due in part to the complexity of the foot – there are a number of muscles, ligaments and nerves all closely linked that risk being damaged with surgery, the potential side effects and from high recurrence rates of the condition following surgery.  A large portion of the plantar fascia needs to be removed to reduce the risk of recurrence. 

Surgery for Plantar Fibromatosis

Surgery for plantar fibromatosis may be performed under general or local anaesthetic and is usually done as a day case.  Following surgery you will need to use crutches for 2-3 weeks to keep any weight off your foot as it heals and it is advisable to keep the foot elevated whenever possible.  You may also need to wear orthotics to support the foot to compensate for the loss of the plantar fascia. 

The common risks associated with surgery are recurrence of the condition, injury to surrounding structures in the foot, loss of the normal foot arches and the development of hammertoe.  It normally takes 1-2 months to return to full function following surgery. 

What Else Could It Be?

There are a number of other conditions that can cause pain in the bottom of the foot.  If plantar fibromatosis isn’t sounding quite like your problem, visit the foot arch pain page in the diagnosis section for help working out what may be causing your problem. 

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