Plantar fascial fibromatosis (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 (myofibroblast and collagen proliferation). It is most often found in the central and medial portion of the plantar fascia. This firm nodule is located on the medial border of the sole of the foot. The nodule is close to the skin and gradually increases in size. It is painful with wearing shoes. This condition is bilateral in about 25% of patients. Early lesion are more cellular. A biopsy may misdiagnose the condition as fibrosarcoma. Older lesions have less cells and more collagen.
Plantar fibromatosis is different from palmar fibromatosis, which causes Dupuytren’s contracture. These conditions can coexist; however, there is no contracture with plantar fibromatosis. Plantar fibromatosis can result from fibroblast proliferation with infiltrative growth that is easily recognized clinically.
If the mass is suspicious, then an MRI or ultrasound may help with the diagnosis. An MRI and ultrasound will show the extent of the lesion. An ultrasound will show diffuse, discrete fusiform thickening of the plantar fascia. These lesions can be multiple and bilateral. The superficial fibers are more affected. It is often difficult to differentiate between a chronic partial tear and a nodule. There is no relationship between the symptoms and the ultrasound appearance. The ultrasound appearance is usually characteristic.
The etiology of plantar fascial fibromatosis is multifactorial and includes:
Plantar fibromatosis occurs in adults and is rarely seen in individuals under the age of 30. Additionally, this condition tends to occur more in males than females.
Nonoperative treatment includes accommodative footwear and inserts. If the lesion is excised, it will lead to a high rate of recurrence. The best treatment is wide resection of the fascia (lower recurrence rate), especially with large nodules that cause severe pain or nerve compression. Surgeons should not operate on painful nodules as they may come back worse than before. A local excision will cause recurrence of the lesion due to the infiltrative nature (lesion is not encapsulated). Post-operative radiation therapy for aggressive fibromatosis was found to improve local control of the lesion. If the mass appears to be suspicious, a biopsy may be needed to rule out soft tissue sarcoma such as synovial cell sarcoma.
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