From the Guidelines
Management of a solid nodule on the left plantar foot that is slightly tender to palpation should begin with a thorough clinical evaluation to determine the cause, and initial treatment options may include rest, ice application, and over-the-counter NSAIDs for pain relief. The most likely diagnoses include plantar fibroma, foreign body granuloma, or plantar wart. Initial conservative treatment includes rest, ice application for 15-20 minutes several times daily, and over-the-counter NSAIDs such as ibuprofen 400-600 mg three times daily with food for pain relief, as suggested by general management principles for heel pain 1. Custom orthotic inserts with a cutout to offload pressure from the nodule can provide significant symptom relief. For plantar fibromas, a trial of topical verapamil 15% gel applied twice daily for 3-6 months may help reduce nodule size.
Some key considerations in the management of this condition include:
- Wearing supportive, cushioned footwear with a wide toe box to reduce pressure on the area
- Avoiding prolonged standing or walking until symptoms improve
- Using heel lifts or orthoses to reduce pressure on the area, as recommended for heel pain management 1
- Considering referral to podiatry or dermatology for further evaluation if initial measures fail to provide relief after 4-6 weeks.
It is essential to note that local injections of corticosteroids are not recommended as an initial treatment option 1, and surgical excision is typically reserved for cases that fail conservative management or when malignancy is suspected. The patient should be advised to follow up regularly to monitor the progression of symptoms and adjust the treatment plan as necessary.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Diagnosis and Management of Solid Nodule on Plantar Foot
- The presence of a solid nodule on the plantar foot, slightly tender to palpation, requires a systematic approach to evaluation and management 2.
- The differential diagnosis for such a lesion is broad and includes both benign and malignant entities, such as lipomas, ganglions, hemangiomas, and popliteal cysts, as well as more serious conditions like Kaposi's sarcoma and amelanotic melanoma 3, 4.
- Imaging studies, such as MRI, can help identify some soft-tissue masses, but a biopsy may be necessary to confirm the diagnosis, especially for indeterminate masses 3.
- Needle biopsy and open incisional biopsy are effective methods for histologically identifying the nature of the tumor, while open excisional biopsy should only be performed when the surgeon is confident that the lesion is benign 3.
Considerations for Biopsy and Management
- The compartmental anatomy of the foot and ankle is important to consider when planning percutaneous biopsy and eventual surgery 5.
- A general overview of the surgical management of benign, benign aggressive, and malignant tumors of the foot and ankle should be considered in the treatment plan 5.
- The diagnosis and management of the lesion should be guided by the results of the biopsy, and the patient should be monitored for any changes in symptoms or lesion characteristics 2, 4.
Differential Diagnosis
- The differential diagnosis for a solid nodule on the plantar foot includes: