Plantar Fibromatosis

Plantar fascial fibromatosis, also known as Ledderhose’s disease, is a benign tumor of the plantar fascia of the foot. It consists of myofibroblasts and dense fibrous proliferation infiltrating the adipose tissue. Therefore, it is myofibroblast and collagen proliferation.

It occurs most often in the central and medial portion of the plantar fascia. The firm nodule of the plantar fibromatosis is located on the medial border of the sole of the foot. It is close to the skin and it gradually increases in size. Additionally, the plantar fibromatosis will be painful with shoe-wearing. When it occurs, plantar fibromatosis will presents bilaterally in about 25% of patients.

Early lesions are more cellular, and the biopsy could therefore be misdiagnosed as fibrosarcoma. On the other hand, older lesions have less cells and now have more collagen.

Plantar fibromatosis is different from palmar fibromatosis, which occurs in the hand. Palmar fibromatosis then subsequently causes Dupuytren’s contracture. Both conditions can coexist, however there is no contracture with plantar fibromatosis like there is with palmar fibromatosis.

Plantar fibromatosis can result from fibroblast proliferation with infiltrative growth that is easily recognized clinically. But, if the mass is suspicious, then an MRI or ultrasound may help with the diagnosis. MRI and ultrasound will also show the extent of the lesion. Ultrasound will show diffuse, discrete fusiform thickening of the plantar fascia. The lesion can be multiple and bilateral. There is no relationship between the symptoms and the ultrasound appearance, and the ultrasound appearance is usually characteristic.

With plantar fibromatosis, the superficial fibers are more affected. In this way, it is often difficult to differentiate between a chronic partial tear and a nodule. The etiology of plantar fibromatosis is usually multifactorial. It can include trauma, familial, diabetes, epilepsy, liver disease, alcohol consumption, and smoking. Furthermore, plantar fibromatosis is rare, and is not usually seen in patients before the age of 30. It also occurs more commonly in males compared to females.

lantar fibromatosis can be treated non-operatively. To do so, accommodative footwear and inserts are worn. Additionally, surgery can be performed to treat this issue. However, if the lesion is excised, it will lead to a high rate of reoccurrence. Therefore, the best treatment is wide resection of the fascia, and this should have a lower recurrence rate compared to excising the lesion. This is especially true with large nodules that cause severe pain or nerve compression. Also, painful nodules at the bottom of the foot should not be operated on, as they may come back worse than before. The nature of the nodule should be studied before it is operated on, as the proper surgery needs to be chosen.

A local lesion will cause recurrence of the lesion due to the infiltrative nature, as the lesion is not encapsulated. Post-operative radiation therapy for aggressive fibromatosis was found to improve local control of the lesion. If the mass appears suspicious, a biopsy may be needed to rule out soft tissue sarcoma, such as a synovial cell sarcoma.