The etiology, evaluation, and management of plantar fibromatosis

Abstract

Plantar fibromatosis (Ledderhose disease) is a rare, benign, hyperproliferative fibrous tissue disorder resulting in the formation of nodules along the plantar fascia. This condition can be locally aggressive, and often results in pain, functional disability, and decreased quality of life. Diagnosis is primarily clinical, but MRI and ultrasound are useful confirmatory adjuncts. Given the benign nature of this condition, treatment has historically involved symptomatic management. A multitude of conservative treatment strategies supported by varying levels of evidence have been described mostly in small-scale trials. These therapies include steroid injections, verapamil, radiation therapy, extracorporeal shock wave therapy, tamoxifen, and collagenase. When conservative measures fail, surgical removal of fibromas and adjacent plantar fascia is often done, although recurrence is common. This review aims to provide a broad overview of the clinical features of this disease as well as the current treatment strategies being employed in the management of this condition.

Follow-up of clinical and sonographic features after extracorporeal shock wave therapy in painful plantar fibromatosis

“…This condition usually progresses slowly and can cause pain, functional disability, and decreased quality of life. Although the etiology remains largely unknown, it is often associated with palmar and penile fibromatosis, which are known as Dupuytren's disease and Peyronie's disease, respectively [1][2][3][4][5].…”

“…Extracorporeal shock wave therapy (ESWT) has been used as a safe alternative treatment for chronic refractory musculoskeletal disease, such as plantar fasciitis Achilles tendinopathy and gluteal tendinopathy [10][11][12][13]. Previous studies have shown that ESWT also can be therapeutically applied to various forms of fibromatosis such as penile fibromatosis [14][15][16][17][18][19] and palmar fibromatosis [20][21][22] to reduce pain and soften nodules, although it did not affect the physical size of the nodules [3,15,16,19,23].…”

“…Ultrasonography or magnetic resonance imaging can be used to confirm the diagnosis and measure the size and depth of the nodule [ 1 – 3 , 6 , 7 ]. Early stage conservative therapy includes non-steroidal anti-inflammatory drugs (NSAIDs), local corticosteroid injections, physical therapy, and custom-made insoles.…”

“…Early stage conservative therapy includes non-steroidal anti-inflammatory drugs (NSAIDs), local corticosteroid injections, physical therapy, and custom-made insoles. Radiotherapy and surgical treatment may be considered in refractory cases [ 1 – 3 ]. However, radiotherapy can cause side effects such as lymphatic edema or fracture of irradiated bone, and surgery has a high recurrence rate that can range from 57% to 100% [ 1 , 3 , 8 , 9 ].…”

Closed-Incision Negative Pressure Therapy in Place of Surgical Drain Placement in Plantar Fibroma Excision Surgery: A Case Series

“…Symptom management is often the treatment of choice for plantar fibromas due to the characteristically benign nature. Some of these treatments include custom or over-the-counter orthotics to help with weight bearing, steroid injections, verapamil, radiation, extracorporeal shock wave therapy, tamoxifen hormonal therapy, and collagenase, all with varying degrees of success and scientific data to back up the effectiveness [1,7].…”