Plantar Fibromatosis - Causes, Symptoms, Diagnosis, and Treatment

What Is Plantar Fibromatosis?

Plantar fibromatosis is a benign (non-cancerous) fibrous tissue disorder that develops in the plantar fascia of the foot. It is a rare condition, and it is a type of musculoskeletal fibromatosis. It contains myofibroblasts and dense fibrous tissue that proliferates and infiltrates the adipose tissue. It is also known as “Ledderhose disease.” It is more commonly seen in adults and has a male predilection. Plantar fibromatosis appears as hard nodules that show a gradual growth. It is often seen bilaterally. The patient often finds severe discomfort due to this condition as it results in pain, difficulty in walking, etc. It does not regress on its own, and it should be treated properly. If untreated, then it may cause severe pain and other complications.

What Is the Difference Between Plantar Fibromatosis and Palmar Fibromatosis?

A fibrosing condition that occurs on the palm is known as palmar fibromatosis, whereas plantar fibromatosis occurs on foot. Palmar fibromatosis is also referred to as Dupuytren's disease or contracture because this condition causes tightening or contractures of tissues in hands and further results in fingers bending down. It affects the function of the hand as the patient cannot straighten their fingers due to the contracture. However, in plantar fibromatosis, there are no contractures seen.

What Are the Causes of Plantar Fibromatosis?

The exact cause of plantar fibromatosis is unknown. However, some of the risk factors that may cause plantar fibromatosis include:

• Family History/Genetic: Plantar fibromatosis may be associated with family history and genetics. If any of the family members have this condition, then one may likely have this condition. Consult the doctor to check for the condition if there are any such cases in the family.

• Racial Predisposition: Plantar fibromatosis is more commonly seen among North European people.

• Medications: Some studies reported certain medications or supplements cause plantar fibromatosis in individuals. That include:

1. Phenytoin (anti-seizure medication).

2. Beta-blockers.

3. Chondroitin and Glucosamine.

4. High doses of vitamin C.

• Traumatic Injury: Traumatic injury to plantar fascia leading to tearing of the fascia favors fibrotic growth (plantar fibromatosis). It is considered to be a primary causative of plantar fibromatosis.

• Some of the other risk factors that predispose to plantar fibromatosis are :

1. Obesity.

2. Diabetes.

3. Chronic liver disease.

4. Alcohol consumption (long-term).

What Are the Symptoms of Plantar Fibromatosis?

Plantar fibromatosis is asymptomatic if it involves only the skin superficially. It produces fewer or no symptoms at the initial stage of the disease. But as it grows gradually, the fibrous growth becomes better, leading to invasion of underlying tissue and causing severe symptoms. The common symptoms seen in plantar fibromatosis include,

1. Pain over the soles of feet.

2. Difficulty while walking.

3. Nodule-like growth over the affected area.

How Is Plantar Fibromatosis Diagnosed?

The doctor will undergo the following diagnostic tests if the patient is suspected of having plantar fibromatosis. It includes,

• Physical Examination: The doctor will primarily undergo a physical examination of the foot to diagnose the condition. Physical examination involves looking for any unusual changes in the foot, like any fibrous growth. It is then subjected to manual palpation to find out whether the growth is fibroma or anything more serious than that. To further delineate clearly about the condition, the doctor may suggest some more tests.

• MRI (Magnetic Resonance Imaging): MRI in plantar fibromatosis shows well-defined nodular growth, which can be either a single nodular or multinodular. It helps in picturizing the extent of invasion of plantar fibromatosis growth, which depicts cases of aggressive forms of plantar fibromatosis.

• Ultrasound: A musculoskeletal ultrasound helps in determining the extent of growth. Foot ultrasound in plantar fibromatosis shows nodular thickening of the plantar fascia.

• Bone Scan / X-ray: A bone scan or X-ray often depicts any changes in the bone around the fibrous growth in the affected area. It helps in delineating whether the growth is plantar fibromatosis or any other cancerous condition like sarcoma.

What Are the Various Treatment Modalities Used to Treat Plantar Fibromatosis?

Plantar fibromatosis does not regress on its own, and often it needs proper treatment. The treatments in plantar fibromatosis mainly focus on relieving the symptoms. The doctor might suggest the following treatment options to treat plantar fibromatosis.

• Steroid Injections: Intralesional steroid injections injected over the nodule will shrink its size and further relieve the pain. For example, Triamcinolone acetonide injection.

• Topical Cream: Doctors may suggest the use of Transdermal verapamil gel (15 %) in plantar fibromatosis cases. It helps in relieving plantar fibromatosis by inhibiting fibrous tissue growth and reducing pain in the affected area.

• Medications: The patient can have medications for plantar fibromatosis only under a prescription from a doctor. A proper consultation with the doctor is necessary before starting any medication for plantar fibromatosis, as the doctor may prescribe medicines based on the dosage requirement, overall health status, and any medicines the patient undertakes for any other health issues. Medications given in plantar fibromatosis include NSAIDs (non-steroidal anti-inflammatory drugs) like Ibuprofen. This helps in reducing the inflammation around the affected area and also relieves pain.

• Orthotic Devices: Orthotic devices are used to support weak muscles while walking.

• Radiation Therapy: Radiation therapy treats plantar fibromatosis by shrinking the size of nodular growth. It is done using high-energy X-rays used in radiation therapy.

• Stretching: Physical therapies like stretching help reduce pain and inflammation, prevent fibrous growth, and promote healing by strengthening the tissue and promoting circulation over the affected area. Proper guidance from a physiotherapist may help in doing the stretching effectively.

• Surgery: Surgery is not a much-preferred treatment option since plantar fibromatosis is close to muscles, tendons, joints, etc. Surgery, at times, may result in further complications by damaging the muscles and tendons near the affected area. It is only considered when all other treatment options provide no relief to the patient.

In severe cases where the condition is still symptomatic despite undertaking all non-surgical treatment options, the doctor may suggest minimally invasive surgery options like Tenex; It involves the use of ultrasonic energy to debride the damaged fibers. It is highly safe as it does not cause any damage to healthy tissues.

How Do You Treat Plantar Fibromatosis at Home?

You can make use of some of the easy home remedies that may relieve pain and discomfort in plantar fibroma, including:

• Applying an ice pack over the affected foot can reduce inflammation and pain. The patient can make use of ice cubes made at home and then pack those ice cubes over a cloth and just dampen them over the affected area repeatedly at close intervals for a duration of 15 minutes. It can be done several times a day or as per the requirement.

• Keeping the affected foot raised over heart level by placing it over a pillow could provide some relief.

Conclusion:

Plantar fibromatosis is a benign condition, and it does not have the potential to become malignant. It is often asymptomatic at the initial stage, but as it grows gradually, it may cause severe pain, walking difficulties, etc. It usually does not regress on its own, and you need proper treatment to relieve the symptoms. Surgery as a treatment option is not required in most cases, but when non-surgical treatment options provide no relief in symptomatic cases, then minor invasive surgery as a treatment option may be considered.