In this episode, we discuss a common condition I see in clinical practice at least several times a week, a plantar fibroma. Also known as Ledderhose disease, the condition involves development of a painful nodule or nodules in the arch that seemingly spontaneously develop. I will review clinical and surgical treatments, what the literature tells us about surgical outcomes, and what you can do for the condition at home.
Plantar fibromas are nodules in the plantar arch area, which may or may not be painful. Histologically a collection of fibroblasts and myofibroblasts, the lesions lie somewhere between excessive scar formation and muscle tissue.
Notoriously resistant to conservative care, these lesions sometimes are simply monitored. If they do not fit a classic pattern, show rapid expansion or become painful, they are often imaged with ultrasound or MRI to confirm the pathology.
First line treatment for these I will recommend shoe and shoe insert modification. Medication such as verapamil is also applied topically, sometimes with warm compresses, in attempt to shrink the lesion. Intralesional cortisone is also sometimes tried. When this fails, surgical management is usually the most effective treatment.
Complete excision is the goal, and this may range from simple isolated nodule removal up to total fasciectomy, depending on size and number of nodules. Surgery is not a benign approach - incision planning, understanding anatomy, and realizing the cost of lesion removal may be a painful scar are all considered before excision.