Call us Toll-Free:   1-888-859-8901
You have no items in your shopping cart.
Filters
Search
Close

Treating plantar fibromatosis with orthotics

Treating plantar fibromatosis

It's always great when a patient makes a comment that makes you re-think everything that you've learned about a condition.  I was meeting with a patient today who wanted to schedule a surgery and said, "hey doc, can you take a look at this little bump on the bottom of my arch?  Is that something that I should have fixed too?"  What the patient was describing was a nodule in the mid arch commonly known as plantar fibromatosis.  There isn't a consensus in the literature as to the origin of plantar fibromatosis but I think most foot surgeons will agree that plantar fibromatosis is due to a micro tear in the fascia that heals with an over proliferation of scar tissue.  That over prolification of scar tissue in the plantar fascia forms the nodule we call plantar fibromatosis.  Clinically plantar fibromatosis is easy to differentiate from other conditions that may exhibit swelling in the mid arch.  Plantar fasciitis is focal, sub dermal and specific to the medial or central slips of the plantar fascia.

The second thing that most foot surgeons are going to agree upon is that you steer clear of asymptomatic cases of plantar fibromatosis.  The re-growth rate of plantar fibromatosis is greater than 25%.  It's not uncommon to take a patient back to the OR for an additional resection of the lesion due to re-growth post surgery.

And that's where my patient had a good point.  She said, "isn't surgery just pre-meditated trauma?  I mean, isn't what you do to take plantar fibromatosis our just an incentive for the fascia to over proliferate with more nodules?"  She has a very valid point.  Does trauma fix trauma?  I think collectively, we still have a lot to learn about plantar fibromatosis.

So what non-surgical alternatives do we have?  The most common non-surgical method used to treat plantar fibromatosis is the use of a supportive insert called an orthotic.  Soft inserts like a gel or foam insert doesn't support the arch enough to unload the fascia.  We've had good success in managing the symptoms of plantar fibromatosis with our SOLE Active Insoles and SOLE Active Insoles with Metatarsal Pads.  As an option, some prescription orthotic labs create a cut-out in the inserts to accommodate the nodule.  I find the primary treatment though is mechanical off-loading of the fascia.  This can be accomplished with a semi-rigid carbon graphite orthotic.

So is the trauma of surgery actually a traumatic contributing factor to the proliferation of plantar fibromatosis?  Interesting thought.  I think that idea is something we'll need to watch in the literature.  And maybe in time, just maybe, we'll find a better, non-surgical way to treat plantar fibromatosis.

Jeff

Dr. Jeffrey Oster

Jeffrey A. Oster, DPM
Medical Director
Myfootshop.com

LinkedIn  l  Facebook

Leave your comment
Comments
8/5/2018 3:03 PM
I have these knodules on both feet. I am very active. Have been all my life. Sports outdoors hunting. I am a mail carrier. Walk 5 miles a day stand 2 hours in morning. I do not want surgery. I would like to know which inserts I would need. Knodules are in the arch. Thank you
8/5/2018 4:20 PM
Hi Rita and welcome. The most common diagnosis is certainly going to be plantar fibromatosis. Please be sure to read our article on the topic located at https://www.myfootshop.com/article/plantar-fibromatosis#Tab3. That'll help you confirm the diagnosis in case you haven't seen a physician to discuss the nodules. Honestly, I find treatment of plantar fibromatosis with arch supports to be somewhat hit and miss in terms of success. Which insert? Part of the success lies in first determining the intended use.(general purpose, standing in a warehouse, tennis, etc) Second question is the type of shoe you intend to wear the insert in.(dress, boots, etc) Your thoughts on use and type of shoe? Jeff Jeffrey A. Oster, DPM Medical Director Myfootshop.com