Plantar fibromatosis is a condition that presents with firm bumps, or nodules, that are found in the plantar fascia.
The onset of plantar fibromatosis varies with each patient. The nodules are typically slow growing and vary in size and location. In some cases, the nodules may lie dormant for months to years only to begin rapid and unexpected growth.
When examined under a microscope, plantar fibromatosis represents a proliferation of scar tissue; almost an overgrowth of scar tissue with in the fascia. Although the origin of plantar fibromatosis is unknown, some authors have speculated that it is a aggressive healing response to small tears in the plantar fascia. It's almost as if the fascia over repairs itself following an injury. Other authors have postulated that plantar fibromatosis is due to a congenital deformity (present at birth) or due to a history of puncture injuries to the foot.
Treatment of Plantar Fibromatosis
Initial treatment of plantar fibromatosis is to avoid direct pressure to the nodules. In many cases, the only pain found with this condition is when the nodule rubs on the shoe or floor. Soft inner soles and padding may be helpful to pad and cushion the nodules.
When plantar fibromatosis becomes painful, most doctors recommend surgical excision of the lesions. In
most cases, the surgery is performed on an out-patient basis using sedation and a local anesthetic. Most cases of plantar fibromatosis require an incision on the bottom of the foot. With a plantar incision, most doctors will require the patient to be
non-weight bearing for a 3 week period of time. As a result, the surgery is not all that difficult to get through, but the recovery, and being on crutches for 3 weeks is a challenge.
A new alternative non-surgical method of
treatment has recently been proposed by pdlabs.
pdlabs proposes the use of topical Verapamil (15%). Verapamil is known to
many patients as a calcium channel blocker, who's primary use is as an
antihypertensive medication (lowers blood pressure). To describe the
action of transdermal verapamil I'll quote directly from pdlab's website...'The
inventor's proposed mechanism of action describes a calcium channel blocker’s
ability to block divalent calcium ions, resulting in the maturation of
fibroblast collagenase and subsequent degradation of the invading plaque.
This plaque is composed primarily of collagen that has been produced in excess
as the result of the body’s healing response to an injury or to a genetically
predisposed condition.' Use of transdermal verapamil is new and the
jury is still out as to whether it is effective in cases of plantar fasciitis.
Another consideration with plantar fibromatosis surgery is the high regrowth rate of these nodules. Estimates of 25% regrowth are not uncommon. Subsequently, most surgeons are going to be fairly aggressive with their dissection and choice of procedures to excise plantar fibromatosis nodules.
The following images show the steps used to excise plantar fibromatosis.
This procedure is performed in a surgery center or hospital and can be completed
using either a local or general anesthetic. The procedure takes between
30-45 minutes to complete. Patients are non-weight bearing following the
procedure for 21 days.
