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.

Fibroma - a firm mass, within or below the level of the skin. In the case of plantar fibromatosis, the nodule is subdermal (beneath the skin).

‘Plantar’ refers to the bottom of the foot.

The plantar fascia extends from the bottom of the heel to the toes and can easily be felt in the bottom of most feet. It originates from two small bumps of bone, referred to as tubercles, on the bottom or plantar surface of the heel bone. It is a very strong structure when placed under tension and does not stretch. The plantar fascia typically consists of two distinct bands; a larger medial (inside of the heel) band and a smaller lateral (outside of the heel) band. The vast majority of cases of plantar fasciitis will originate at the medial tubercle and medial band. The nodules found in plantar fibromatosis can be found at any section of the plantar fascia.

The jury is still out regarding the etiology of plantar fibromatosis, but trauma to the fascia does seem to be the most plausible explanation.  When one considers the biomechanical properties of the plantar fascia, there is one consistent fact; the load that is applied to the plantar fascia with each and every step is significant. If indeed plantar fibromatosis is caused by repetitive loading and subsequent tearing of the fascia, we can understand why. Each time we apply our body weight to the foot, the fascia becomes taught. With each step, a complex mechanical lever arm called a Windlass Mechanism works to stabilize the arch of the foot making the foot rigid for the toe off phase of gait. During all of this mechanical activity, the plantar fascia is significantly loaded and very susceptible to injury.

The symptoms of plantar fibromatosis are usually due to direct pressure to the lesions from the floor or shoe. Many cases are asymptomatic due to the lesion being located in a non-weight bearing portion of the bottom of the foot.

Foreign objects
Dermatofibroma (a fibroma of the skin)
Abcess

• Achilles Tendonitis

• Plantar Fasciitis

• Calcaneal Fractures

• Tarsal Tunnel Syndrome

• CT Band Syndrome

This article was written by Jeffrey A. Oster, DPM and last updated 6/13/07. No additional information is available for this topic.