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A plantar fibroma is a benign tumour (growth) of the plantar fascia. It is composed of dense fibrous tissue. It tends to be a solitary lesion and quite superficial. It tends to be slow growing.
Patients with multiple lumps are said to have plantar fibromatosis, also known as Lederhose disease. The lumps are found in deeper layers and can be faster growing. This is also a benign condition.
MRI of the foot in a patient with a plantar fibroma
No one knows the exact underlying cause of plantar fibroma.
Plantar fibromatosis, (Lederhose disease) has an association with Dupuytren contracture of the hand. This is a similar condition affecting the palm of the hand resulting in thickened bands and contractures of the palmer fascia. Plantar fibromatosis, like Dupytrens, is linked with chronic alcoholism, chronic liver disease, epilepsy and repetitive trauma.
A clinical picture of a patients hand demonstrating Dupytren’s disease
Other causes of lumps in the sole of the foot include:
Quite often there are no symptoms. Patients may only notice a firm swelling on the sole of the foot.
Some patients complain of difficulty in standing, walking, or wearing shoes when the nodules or bumps become large enough.
The lump is typically found in the middle of the arch on the sole of the foot.
Clinical picture of the foot demonstrating a large painful plantar fibroma
MRI is useful in detecting plantar fibroma and fibromatosis. An MRI will confirm the diagnosis and allow differentiation of other causes of masses in the foot.
MRI is particularly useful in assessing:
Lumps can get bigger and more painful.
Many patients have lumps that cause no symptoms and therefore can be observed.
Non-operative management aims at relieving pain.
It should always be the first line of treatment. Options include:
An off-loading insole or pad may relieve painful symptoms.
Well padded shoes.
Stretching tight calf muscles will help reduce the forces going across the forefoot. Plantar fascial stretches.
Surgical management is reserved for patients who have failed to respond to non operative treatment.
Patients should understand that the decision to undergo surgery should not be taken lightly.
Any intervention is considered in a step wise manner, with the least invasive procedure carried out first.
Carried out through an incision overlying the lump in line with the foot. To ensure low recurrence rates wide margins are recommended. The lump os sent to histology to confirm the diagnosis.
Complications can occur as with any type of surgery. Please see foot and ankle complications for more detailed explanation of post surgical complications.
Please read the information regarding what to expect post surgery on this website.
Remember that below is a guide to recovery and that everyone heals at different rates and some people do take longer. Use this information to help you understand your condition, possible treatment and recovery. The timeframes given below are a minimum, it is important that you appreciate this when considering surgery as your healing and recovery may take longer.
Almost all surgical procedures for plantar fibroma and plantar fibromatosis will be undertaken as a day case.
You will have a bandage applied similar to this during the operation.
Post operative bandage of the foot
Please do not remove your bandages until you are seen by your surgeon Mr Malik at the two week post operative clinic appointment. You will also be provided with a stiff soled black post operative shoe. Please ensure you wear this whenever you are mobilising.
Post operative stiff soled shoe
For the first 2 weeks following surgery you will be non weight bearing using two crutches. The physiotherapist will guide you after your operation and before your discharge from hospital with the use of crutches and mobilising.
For the first two weeks following your surgery please keep your foot elevated to the level of your heart for 95% of the time. It is recommended you stay at home during this period to prevent complications and allow the wound to heal.
High elevation of the foot and ankle
Naturally most people do not have a hospital bed at home. The same effect can be achieved by lying in a bed or lengthways on a sofa, with pillows behind your back and under your foot. You cannot have your leg elevated sitting in a chair. It is strongly advised that during the first two weeks you are house bound.
To minimise risk of infection keep the foot dry and cool. Avoid humid and hot environments. Keep the foot dry and when showering wear a Limbo bag.
To minimise the risk of blood clots please move your foot and ankle at regular intervals. Please ensure you are well hydrated. If you have a risk of blood clots please notify Mr Malik who may organise for you to have blood thinning injections as a precaution.
You will be reviewed at the clinic and your dressings removed. Your wound will be checked.
At this stage if the swelling has subsided sufficiently you will be advised to keep your foot in an elevated horizontal position (50-75% of the time). Depending on the size and healing of the wound you may commence weight bearing. Some patients with large lumps and evidence of delayed healing may require to be non weight bearing for a longer period.
Driving will be permitted for short trips if the left foot has been operated on and you drive an automatic. If the right foot has been operated on it will be at least 8 weeks before any driving is advisable.
Scar desensitisation should start as soon as the wound has completely healed. You can do this by massaging cream (E45 for example) into the scar and around the wound area.
Most patients are able to start wearing normal footwear (swelling permitted) and return to full activities. Final clinical examination. Discharge if satisfactory.
This depends on your rate of healing and how much pain and swelling you have. For the first 6 weeks we advise you to use the stiff post operative shoe. After 6 weeks it is advised that you wear a well cushioned shoe while your foot continues to heal.
Please see guidance above and information here. Ultimately it is the responsibility of the patient to decide if they are safe to drive. A good way of knowing is if you can stamp your right foot heavily on the ground to mimic an emergency brake. If you have any hesitation or pain then it should suggest you are not safe to drive. Remember prolonged driving involves keeping your feet in a dependant position. This will worsen the post operative swelling.
This really depends on you and your job. If you have a job that involves a lot of standing, walking and is manual it may be 4 to 8 weeks. If you have a sedentary job, for example in an office and you have a reasonable commute you may be able to go back to work at 2 weeks, although this would be exceptional and not the norm.
Excellent pain relief. Ability to participate in sports by 2 to 3 months. Sometimes up to a year before the foot feels “normal” and fully healed.
Orthopaedic Outpatient Department 30 Devonshire Street, London, W1G 6PU
tel: +44 (0) 203 7956053
Mon - Fri (8am-8pm) Sat (9am - 5pm)
info@lfaclinic.co.uk
