Plantar fibromatosis is a
benign tumor specific to the plantar fascia. Plantar fibromatosis presents with firm bumps, or nodules, that are found
within the plantar fascia.
The onset of plantar fibromatosis varies with each patient. The
plantar fibromatosis nodules are 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
focal proliferation of scar tissue within, and specific to, the plantar fascia. Although the origin of plantar fibromatosis is unknown,
many authors have speculated that plantar fibromatosis is an aggressive healing response to small tears in the plantar fascia.
Plantar fibromatosis may be considered the healing response of the fascia in
response to 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 conservative treatment of plantar fibromatosis includes
avoidance of direct pressure to the plantar fibromatosis nodules. In many cases, the only pain found with this condition is when the nodule
is irritated by direct pressure from the shoe or floor.
Soft
arch supports and padding may be helpful to pad and cushion the
plantar fibromatosis nodules.
If plantar fibromatosis is due to mechanical load applied to the
plantar fascia through the
CT
band, weakening the calf with
calf stretches
or the use of a
heel lift can help.
Night splints have also been used successfully to weaken the calf.
If plantar fibromatosis becomes painful, doctors recommend surgical excision of the lesions.
Surgery for plantar fibromatosis requires an incision on the bottom of the foot.
When a plantar incision is used, patients are required to be non-weight bearing
for a 3 week period of time. Non-weight bearing following surgery is important
to prevent the formation of excessive scar tissue at the site of the incision.
One consideration with plantar fibromatosis surgery is the high regrowth rate of
plantar fibromatosis nodules. The literature cites regrowth rates of plantar
fibromatosis as high as 25%. Subsequently, in an effort to limit regrowth, most surgeons are going to be 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 for 21 days
following the procedure.
