What is plantar fibromatosis?

From the Guidelines

Plantar fibromatosis should be initially managed with clinical and radiologic surveillance, as systemic treatments may be offered following initial surveillance for patients with symptomatic disease progression. When considering treatment options for plantar fibromatosis, it is essential to prioritize a conservative approach, focusing on managing symptoms and monitoring disease progression. According to the UK guidelines for the management of soft tissue sarcomas 1, initial standard treatment for fibromatosis, including plantar fibromatosis, involves clinical and radiologic surveillance.

Key Considerations

• The condition is characterized by the development of fibrous nodules in the plantar fascia of the foot, leading to pain and discomfort, especially when walking.
• Conservative measures such as stretching exercises, orthotic devices, and comfortable shoes with good arch support can help alleviate symptoms.
• For pain management, over-the-counter NSAIDs like ibuprofen can be used, and physical therapy focusing on stretching the plantar fascia and Achilles tendon is beneficial.
• Corticosteroid injections may be considered for persistent pain, though they carry risks of fascia weakening.
• Surgical removal of the nodules may be necessary for severe cases unresponsive to conservative treatment, though recurrence is possible.

Systemic Treatments

Systemic treatments may be offered following initial surveillance for patients with symptomatic disease progression of fibromatosis 1.

Radiotherapy and Local Ablative Therapies

Radiotherapy and other local ablative therapies may be used for fibromatosis at critical sites 1. It is crucial to weigh the potential benefits and risks of each treatment option, considering the individual patient's needs and disease characteristics. By prioritizing a conservative approach and carefully selecting patients for more invasive treatments, healthcare providers can optimize outcomes for patients with plantar fibromatosis.

From the Research

Definition and Characteristics of Plantar Fibromatosis

• Plantar fibromatosis, also known as Ledderhose disease, is a rare, benign, hyperproliferative fibrous tissue disorder resulting in the formation of nodules along the plantar fascia 2.
• This condition can be locally aggressive, and often results in pain, functional disability, and decreased quality of life 2.
• The main clinical characteristics include slow growing nodules on the medial and central bands of the plantar fascia, which may become painful and negatively affect ambulation 3.

Diagnosis of Plantar Fibromatosis

• Diagnosis is primarily clinical, but MRI and ultrasound are useful confirmatory adjuncts 2.
• A systematic review of PubMed, Google Scholar, and Cochrane reviews computerized database was performed focusing on the different types of treatments for plantar fibromatosis, using keywords such as "plantar", "fibromatosis", "Ledderhose", "Dupuytren", "foot" 4.

Treatment Options for Plantar Fibromatosis

• Given the benign nature of this condition, treatment has historically involved symptomatic management 2.
• Conservative treatment strategies include steroid injections, verapamil, radiation therapy, extracorporeal shock wave therapy, tamoxifen, and collagenase 2.
• Operative outcomes are reported for 178 patients, with 196 feet treated, and valid conservative methods are presented in literature, with debated results 4.
• Surgical removal of fibromas and adjacent plantar fascia is often done, although recurrence is common 2.
• Wide excision is recommended in selected cases, and further clinical trials with well-defined and standardized outcome measurements should be necessary in future to better evaluate success rate and complications of the various procedures 4.

Surgical Techniques and Outcomes

• A consecutive series of five primary procedures on patients with painful plantar fibroma and seven revision operations on patients with recurrent plantar fibroma were presented, with an average follow-up of 47 months in the primary group and 40 months in the revision group 5.
• The overall results were satisfactory in four of the five primary operations, with only one recurrence, and five of seven results were satisfactory with no recurrences in the revision group 5.
• Clinical results were evaluated retrospectively in 11 patients (13 feet) who underwent 24 operations, including local excision, wide excision, or complete plantar fasciectomy, and recurrence of plantar fibromatosis after surgical resection can be reduced by aggressive initial surgical resection 6.