From the Guidelines
Plantar fibromatosis treatment should initially focus on conservative management with options such as open-backed shoes, heel lifts or orthoses, NSAIDs, decreased activity, stretching exercises, and weight loss, as these approaches prioritize reducing morbidity and improving quality of life. When considering treatment for plantar fibromatosis, it's essential to prioritize methods that minimize invasiveness and promote symptom relief while considering the potential impact on morbidity, mortality, and quality of life.
- Key considerations include:
- The use of open-backed shoes to reduce pressure on the affected area 1
- Implementation of heel lifts or orthoses to alleviate stress on the plantar fascia
- Administration of NSAIDs for pain management
- Decreased activity to avoid exacerbating the condition
- Stretching exercises to improve flexibility and reduce tension in the plantar fascia
- Weight loss, if indicated, to decrease the load on the plantar fascia
- It's also important to note that local injections of corticosteroids are not recommended 1, highlighting the need for caution when considering invasive treatments that may have adverse effects on tissue health and potentially increase morbidity.
- In cases where symptoms persist or are severe, immobilization may be considered 1, underscoring the importance of a tailored approach that balances the need for symptom relief with the potential risks of more invasive interventions.
- The primary goal of these treatments is to address the symptoms of plantar fibromatosis effectively while prioritizing the patient's quality of life and minimizing the risk of complications that could impact morbidity and mortality.
From the Research
Treatment Options for Plantar Fibromatosis
- Conservative treatment strategies for plantar fibromatosis include steroid injections, verapamil, radiation therapy, extracorporeal shock wave therapy, tamoxifen, and collagenase 2
- Surgical removal of fibromas and adjacent plantar fascia is often done when conservative measures fail, although recurrence is common 2
- Valid conservative methods are presented in literature, with debated results, and some operative options show high recurrence rate; wide excision is recommended in selected cases 3
- Operative treatment is indicated in case of persistent pain or if conservative measures fail, and a complete fasciectomy is recommended not only in recurrent disease, but also as the primary procedure of choice 4
- Most established conservative therapies today target symptomatic relief, and therapies such as injections, shockwave ablation, radiation, and/or surgery may be required as symptoms progress 5
Comparison of Treatment Outcomes
- A systematic review of 25 citations and 233 patients found that operative outcomes are reported for 178 patients, with 196 feet treated, and valid conservative methods are presented in literature, with debated results 3
- Further clinical trials with well-defined and standardized outcome measurements are necessary to better evaluate success rate and complications of the various procedures 3
Additional Therapies
- Acupuncture should be considered as a major therapeutic instrument for the decrease of heel pain, combined with traditional medical approaches, although this study was focused on plantar fasciitis, not plantar fibromatosis 6