What is the management of symptomatic plantar fibroma?

From the Guidelines

Management of symptomatic plantar fibroma begins with conservative approaches, prioritizing comfortable shoes, custom orthotic inserts, and physical therapy to reduce pressure and alleviate symptoms, as recommended by the most recent guidelines 1. The initial treatment approach should focus on reducing pressure on the nodule and alleviating symptoms. This can be achieved by:

• Wearing comfortable shoes with adequate arch support and cushioning to reduce pressure on the nodule
• Using custom orthotic inserts to redistribute weight away from the fibroma
• Engaging in physical therapy, including stretching exercises for the plantar fascia and Achilles tendon, to provide relief For pain management, over-the-counter NSAIDs like ibuprofen (400-800mg three times daily with food) can be used, as suggested by general medical knowledge. However, corticosteroid injections are not recommended as a first-line treatment, according to the American College of Foot and Ankle Surgeons 1. If conservative measures fail after 6-12 months and the fibroma significantly impacts daily activities, surgical excision may be considered, though recurrence rates range from 20-40% and surgery may lead to scarring or altered foot biomechanics, as noted in general medical knowledge. Radiation therapy is occasionally used for aggressive or recurrent cases, but its use is not well-established in the guidelines provided 1. The underlying cause of plantar fibromas remains unclear, though they appear to involve abnormal fibroblast proliferation and collagen production, which explains why complete resolution with non-surgical approaches is uncommon, as suggested by general medical knowledge.

Key considerations in managing symptomatic plantar fibroma include:

• Reducing pressure on the nodule through comfortable shoes and custom orthotic inserts
• Alleviating symptoms through physical therapy and pain management
• Avoiding corticosteroid injections as a first-line treatment
• Considering surgical excision if conservative measures fail and the fibroma significantly impacts daily activities
• Being aware of the potential risks and limitations of treatment options, including recurrence rates and altered foot biomechanics.

From the Research

Management of Symptomatic Plantar Fibroma

The management of symptomatic plantar fibroma can be divided into conservative and surgical options.

• Conservative options include:
  • Stretching
  • Orthotics
  • Nonsteroidal antirheumatic drugs
  • Local cortisone-injections
  • Physiotherapy 2
  • Steroid injections
  • Verapamil
  • Radiation therapy
  • Extracorporeal shock wave therapy
  • Tamoxifen
  • Collagenase 3
• Surgical options include:
  • Partial fasciectomy of the plantar aponeurosis 2, 4
  • Total fasciectomy 2, 5
  • Wide excision 6, 5
  • Staged revision procedure with delayed split-thickness skin graft closure 5

Efficacy of Management Options

• Partial fasciectomy has been shown to be a useful treatment option for symptomatic plantar fibromatosis, with a low recurrence rate of 6% and minor complications such as scar-related problems 4
• Total fasciectomy is recommended as the primary procedure of choice, especially in cases of recurrent disease, due to the high recurrence rate and risk of complications associated with partial fasciectomy 2
• Wide excision is recommended in selected cases, with satisfactory results in 5 of 7 revision operations and no recurrences 5
• Conservative methods have debated results, and further clinical trials are necessary to evaluate their success rate and complications 6