Plantar Fibromatosis

Written By: Chloe Wilson - BSc(Hons) Physiotherapy
Reviewed By: FPE Medical Review Board

Plantar Fibromatosis is a foot condition where small nodules grow on the sole of the foot. Find out about the common causes, symptoms and treatment options

Plantar Fibromatosis is a foot condition where a small nodule, a fibroma, grows in the arch of the foot on the plantar fascia. 

A plantar fibroma is a benign growth i.e. non-cancerous, which tends to be slow growing and usually less than an inch in size.  

Plantar fibromatosis 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. 

What Is Plantar Fibromatosis?

In plantar fibromatosis, thickenings develop in the plantar fascia, the thick band of fibrous tissue on the bottom of the foot.

Plantar Fibromatosis aka Ledderhose Disease: Causes, Symptoms, Diagnosis & Treatment

The plantar fascia runs between the heel and the toes, helping to support the arches of the foot. 

The thickenings in the plantar fascia can end up forming small nodules, plantar fibromas, 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.

Plantar Fibromatosis Symptoms

Common symptoms of Ledderhose Disease include:

Plantar Fibromatosis is characterised by a small lump underneath the foot
  • Visible Nodule: The most common symptom of plantar fibromatosis is a small lump under the skin on the sole of the foot. These nodules tend to be on the inner side of the sole of the foot, at the highest point of the foot arch. 

    Plantar Fibroma nodules are usually 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 plantar fibroma growths remain permanently unless removed surgically, they don’t just spontaneously resolve.

  • Foot Pain: Often plantar fascial 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 plantar fibroma nodule, either from prodding it, pressure from shoes or weight bearing through the foot when standing, walking or running
  • Toe Stiffness:  As plantar fibromatosis progresses, it can cause thickening of the plantar fascia. This can result in contractures and tightness which cause the toes to bend, limiting toe movements, causing stiffness and making walking difficult.

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

What Causes Ledderhose Disease?

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

  • Genetics: A family history of Ledderhose Disease is the strongest risk factor for developing plantar fibromatosis

  • Gender: Plantar Fibromatosis is more common in men then women with a male:female ratio of 2:1

  • Medical Conditions: Diabetes, epilepsy, liver disease and Peyronie’s disease are thought to be associated with increased risk of developing plantar fibroma

  • Long-term Alcohol Consumption: is thought to increase the risk of developing Ledderhose Disease

  • 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, such as plantar fasciitis.  MRI tends to be more accurate than x-ray or ultrasound, showing the full extent of the condition. 

How Do You Treat Plantar Fibromatosis?

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

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 never cause any problems. If there is no pain associated with the plantar fibroma, then active treatment is not needed.

Non-Surgical Treatment

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

  • Injections: Corticosteroid injections can help relieve the pain and reduce the size of the growth but the effects are often short lived.  Injections are most effective in the early stages of plantar fibromatosis

  • Orthotics:  Wearing shoe insoles or special padding can help to reduce the force through the nodules, making walking more comfortable

  • Physiotherapy: Treatment such as stretching exercises, ultrasound and shock wave therapy may help reduce plantar fibromatosis pain

Surgery For Plantar Fibromatosis

Surgery for Ledderhose Disease to remove a plantar fibroma

Plantar fibromatosis surgery may be performed under general or local anaesthetic and is usually done as a day case. 

Following ledderhose 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 for plantar fibromatosis are recurrence of the fibroma, 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 ledderhose surgery.  

Surgery for plantar fibromatosis should only be considered when there have been 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. 

Your Questions Answered

Can A Plantar Fibroma Go Away? Without treatment a plantar fibroma is unlikely to get smaller or go away. The symptoms of plantar fibromatosis will settle with treatment, but the fibroma itself will remain unless surgically removed.

Is Plantar Fibromatosis Cancerous? No, a plantar fibroma is not cancerous. It is simply a mass of fibrous tissue in the foot which is completely benign i.e. non-malignant

Is Plantar Fibromatosis The Same Thing As Plantar Fasciitis? No, fibromatosis and fasciitis are different conditions. Plantar fibromatosis is when a nodule grows in part of the plantar fascia. Plantar fasciitis is when there is damage and inflammation to the plantar fascia.

Is Ledderhose Disease Painful? Some people with Ledderhose disease do not get any pain at all, and may be completely unaware of the plantar fibroma. As the fibroma grows however, it may start pushing on surrounding tissues and causing pain when there is any pressure through the foot.

How Common Is Plantar Fibromatosis? Plantar Fibromatosis is a relatively rare disease which affects less than 1% of the population. This figure however rises to around 25% in people over the age of 65. It is 10 times more in common in men than women.

How Do You Stretch A Plantar Fibroma? You cannot stretch a plantar fibroma directly, but you can stretch the plantar fascia which it sits in. Rolling a golf ball or can underneath your foot is a great way to stretch out the area. Visit the plantar fascia stretches section to find out loads more. 

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. 

  1. Foot Pain Guide
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  3. Common Foot Problems
  4.  ›
  5. Plantar Fibromatosis

Page Last Updated: 2019-06-19
Next Review Due: 2021-06-19

References

1. The Journal of Clinical and Aesthetic Dermatology - Ledderhose Disease: An Unusual Presentation. D. Fausto de Souza, L. Micaelo, T. Cuzzi and M. Ramos-e-Silva. September 2010

2. American Journal of Surgery - Incidence and treatment of recurrent plantar fibromatosis by surgery and postoperative radiotherapy. de Bree E, Zoetmulder F, Keus R, Peterse H and van Coevorden F. January 2004

3. Foot & Ankle Specialist Journal - Plantar Fibromatosis: Pathophysiology, Surgical and Nonsurgical Therapies: An Evidence-Based Review. Carroll P, Henshaw R, Garwood C, Raspovic K, Kumar D


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