What is the management of plantar fibromatosis (plantar fibroma)?

From the Guidelines

The management of plantar fibroma should prioritize conservative approaches, focusing on reducing pressure and alleviating symptoms, rather than immediate surgical intervention, due to the benign nature of the condition and potential risks associated with more aggressive treatments. When considering the management of plantar fibroma, it's essential to weigh the benefits and risks of various treatment options, keeping in mind the goal of minimizing morbidity, mortality, and improving quality of life. Key considerations include:

• Wearing open-backed shoes to reduce pressure on the area, as suggested by the American College of Foot and Ankle Surgeons 1.
• Utilizing heel lifts or orthoses to further alleviate pressure.
• Employing NSAIDs for pain management, alongside decreased activity and stretching exercises to reduce discomfort.
• Avoiding local injections of corticosteroids, as they are not recommended 1. In cases where symptoms persist or are severe, more invasive treatments like immobilization may be considered, but these should be approached with caution and typically after conservative measures have been thoroughly explored. Given the information available, the approach outlined by the American College of Foot and Ankle Surgeons 1 provides a foundation for the initial management of plantar fibroma, emphasizing conservative treatments to manage symptoms and improve patient outcomes.

From the Research

Management of Plantar Fibroma

The management of plantar fibroma, also known as plantar fibromatosis or Ledderhose disease, involves both conservative and surgical treatment strategies.

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

Treatment Outcomes

The success rate and functional outcome of these treatment options vary, with some studies reporting high recurrence rates after surgical treatment 3, 5.

• A systematic review of 25 citations found that valid conservative methods are presented in literature, with debated results, and some operative options show high recurrence rates 5.
• A study of 12 patients who underwent primary or revision surgery for plantar fibroma reported satisfactory results in 9 patients, with 2 recurrences and 1 postoperative neuroma 4.

Future Directions

Further clinical trials with well-defined and standardized outcome measurements are necessary to better evaluate the success rate and complications of the various procedures for plantar fibroma 5.