Plantar fibroma, also known as Ledderhose’s disease, Morbus Ledderhose, or plantar finromatosis, is in simple terms, a fibrous knot or nodule that forms in the arch of the foot. It is a non-malignant thickening of the connective tissue or fascia, a set of tissues that run from the heel to the toes at the bottom of the feet. The nodules or cord initially grow along the tendons of the foot, and though it is not a serious condition, it can be painful. It can develop in one or both feet, and it does not get smaller or go away without treatment.
The definitive causes for this condition are still not known. However, studies have reported that plantar fibroma is more common in people who have suffered repeated trauma, have a chronic liver condition, have a history of alcohol consumption, or are epileptic or diabetic. The occurrence rate is more or less equal for men and women, and the condition is quite progressive for men above the age of seventy.
Plantar fibroma is benign and is slow growing. It may lie dormant for a long period of time with sudden growth bursts. The signs of symptoms of plantar fibroma are the presence of a lump in the arch of the foot that is firm to touch. This lump can remain the same in size or suddenly show an increase in size, and the pain is said to intensify during the growth bursts. However, not all people with plantar fibroma experience pain. Pain is mostly felt when the feet are pushed against the shoes or the floor, while standing, or when walking.
The diagnosis of plantar fibroma is done by the physician who examines the foot and the ankle and presses the affected area. A biopsy or MRI may be required to evaluate and diagnose the condition.
Treatment for plantar fibroma is most often administered through medication aimed at bringing relief, as the mass does not go away even with treatment. In initial stages, the nodule will be single and small, and the best way to reduce pain is to wear soft inner soles in footwear.
It is difficult to perform surgery for plantar fibroma as the tendons, muscles, and nerves are located very close to one another. Surgery in this case can lead into unpleasant complications. Non-surgical treatment options include steroid injections, orthotic devices, and physical therapy. Corticosteroid injections help ease the pain and are also said to help shrink the mass. This reduction in size can be temporary as the nodule may return to its previous size, requiring more injections. In case the fibroma does not change in size and is stable, one can use shoe inserts like custom orthotic devices that will reduce pain by enabling the distribution of the person’s weight away from the swelling. The condition can be treated by physical therapy which provides anti-inflammatory medication to relieve the pain.
Surgical treatment is opted for only if the fibroma continues to grow and causes severe pain. This requires the removal of most of the plantar fascia ligament, as there is a possibility of re-growth if the mass is not removed completely. This means that the ligament used to maintain the arch in the foot is removed and additional support is needed. As the surgery needs incision along the bottom of the feet, the scar tissues can be painful even after recovery. After surgery, the person needs to rest the foot for about four weeks, and gentle physiotherapy is given to strengthen the muscle and help get back on feet.
As there is higher probability for recurrence in plantar fibroma, it is essential to have continued follow-up visits with the doctor.
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