Plantar fibromatosis is a rare condition in which benign (non-cancerous) tumors called plantar fibromas grow on the bottom (plantar surface) of the foot. The plantar fascia is a long band of connective tissue that runs from the heel to the toes on the bottom of the foot. Plantar fibromas are firm masses that grow slowly along the plantar fascia, and they contain excess collagen or fibrotic tissue. They can be present in one or both feet. While Peyronies Disease may resolve on its own, plantar fibromatosis rarely does. Patients taking the medication Dilantin (an anti-seizure medication) have a higher risk of developing plantar fibromas. The reason for this higher incidence is not known. Non-malignant tumors may also develop after there has been damage to the plantar fascia.
In the early stages of this condition, the fibromas are small and do not interfere with the function of the foot. As the fibromas continue to grow, bending the toes becomes more difficult and walking becomes painful. Duputren’s disease is a similar condition that affects the hands.
Plantar fibromatosis is more common in Caucasians than in any other race, and ten times more common in males than females. Plantar fibromas are more common in middle-aged and elderly people, especially men over seventy. There is another condition called superficial plantar fibromatosis that is more common in children than adults. This condition is also known as Ledderhose’s disease, or Morbus Ledderhose. This condition is bilateral (occurring in both feet) in 25 percent of cases. Juvenile aponeurotic fibroma (JAF) and aggressive infantile fibromatosis (AIF) are also a part of the fibromatosis group. These conditions may be present at birth.
Plantar Fibromatosis Symptoms
Symptoms of this condition may include a pain and a noticeable lump in the arch that is firm to the touch and may grow over time. Multiple fibromas may develop.
Pain is not always present when plantar fibromas begin developing. Some patients complain of pain or discomfort while wearing shoes that push against the arch, or when standing barefoot. Symptoms vary depending upon the type, size, and locations of the plantar fibroma.
What Causes Plantar Fibromatosis?
It is still unclear what causes plantar fibromatosis, but most patients have one or more of the following in common:
- Family history of the condition
- Caucasian males over 70
- Diabetes mellitus
- Palmar fibromatosis
- Peyronie’s disease
- Liver disease
- Thyroid problems
- Overuse of the feet over long periods of time
Although the cause of plantar fibromatotis is still not known, trauma is thought to have a role in the development of this condition. A puncture wound or micro-tear can cause formation of fibromas.
Some medications have been linked to fibrotic tissue disorders. These include anti-seizure medications like Phenytoin, beta-blocker supplements such as glucosamine/chondroitin, and large doses of supplemental vitamin C can promote the production of excess collagen and fibrotic disorders. Make sure your doctor is informed of any medications or supplements you are taking, and is aware of your medical history. Fifty percent of patients with plantar fibromatosis have Duputren’s Disease.
Diagnosing Plantar Fibromatosis
Differential diagnosis should include post traumatic neuroma, fibrosarcoma, synovial sarcoma, epithelial sarcoma, and inclusion body fibromatosis. With excision of plantar fibromas, misdiagnosis is rare. Although x-rays are usually required prior to advanced imaging studies, they are not sufficient to diagnose fibromas. Podiatrists use MRI (magnetic resonance imaging studies) to visualize plantar fibromas. An MRI will assist your doctor in determining the shape, size, and depth of the fibroma. Many reach the aponeurosis (the flat, fibrous sheet of connective tissue that attaches muscle to bone). Your doctor will need to know about your medical history, medications, lifestyle, supplements, symptoms, and family medical history.
Plantar Fibromatosis Treatment
Treatment will depend upon the size and location of the fibromas, and whether or not they are causing pain. When plantar fibromas are small and cause minimal pain, treatment usually consists of alleviating direct pressure to the fibroma. This is accomplished through padding, functional foot orthotics, night splints, heel lifts, or arch supports. Pressure reduction has been shown to shrink the fibromas. Verapamil 15% gel (a calcium channel blocker used to treat angina, irregular heartbeat, and high blood pressure) has been shown to shrink plantar fibromas. The verapamil gel is applied to the mass twice daily.
There are also two invasive treatment options available: cortisone injections and surgery. Cortisone injections may be helpful, but can cause the fibroma to enlarge and possibly multiply. If the mass is painful and conservative methods have failed, the fibroma may be surgically removed. Unfortunately, even if it is surgically removed the fibroma may grow back. Complications from surgical removal may include hammertoes and flat feet. The decision to intervene surgically is made on a case-by-case basis. The procedure is performed at the hospital or in a surgical center. You will need someone to drive you home after the procedure due to the effects of the anesthesia. You will need to use crutches or a walker for three to four weeks following the procedure.
Preventing Plantar Fibromatosis
Because the cause of plantar fibromatosis is unknown, it is nearly impossible to prevent. By recognizing the symptoms and seeking medical treatment quickly, you can prevent the condition from worsening. Other things you can do include:
- Perform stretching exercises, especially for your plantar fascia (see Plantar Fasciitis Exercises).
- Maintain a healthy weight.
- Drink plenty of fluids each day.
- Wear footwear that supports, protects, and stabilizes your feet.
- Wear appropriate footwear for whatever you are doing.
- Maintain a healthy diet.
- Warm up before exercising and cool down afterward.
- Begin new exercise routines slowly.
- Rest your feet as often as possible.
- Examine your feet for any changes you may not feel.
Talking to Your Doctor
Here are some questions you may want to ask your doctor about plantar fibromatosis or fibromas:
- Will I need surgery?
- After treatment, how likely is it the condition will recur?
- Will treatment prevent me from engaging in my normal daily activities?
- Would I benefit from orthotics?