by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Within the plantar fascia of the foot, firm, nodular masses may form. These can occur as a single mass or in clusters.
They are called plantar fibromas and are a benign tumor. Frequently, they will slowly enlarge causing pain while walking. Damage to the fascia will cause their occurrence and there is an association with taking the drug Dilantin. In 10% of the cases, patients will also demonstrate similar lumps in the palms of the hands called Dupuytren’s contracture.
Plantar fibroma represents a broad spectrum of conditions with the common characteristics of plantar location and histologic features of mature collagen and fibroblasts with no malignant features.
The term plantar fibromatosis is used for different conditions, the most common being a relatively common plantar equivalent of Dupuytren palmar contracture named Ledderhose disease. Repeated trauma, excessive alcohol consumption, chronic liver disease, diabetes, and epilepsy have been reported in association with the development of the lesions in middle-aged or elderly people.
Diagnosis is made by clinical exam. MRI can confirm the diagnosis.
Treatment consists of padding the area to reduce pressure. Functional foot orthotics will take the strain off of the plantar fascia ligament. Cortisone injections are of little value. Whenever surgery is contemplated, the patient should wear a functional foot orthotic following the surgery. The orthotic helps to accommodate for the loss of the plantar fascia, which is removed at the time of surgery.
A recent review…
Foot Ankle Int. 1995 Sep;16(9):548-51.
Plantar fibromatosis: a review of primary and recurrent surgical treatment.
Wapner KL, Ververeli PA, Moore JH Jr, Hecht PJ, Becker CE, Lackman RD.
Department of Orthopaedic Surgery, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
Plantar fibromatosis can be quite disabling to the patient, as well as a technical challenge to the surgeon. Patients who undergo previous local excisions and in whom aggressive recurrences develop are difficult to manage successfully. We present a consecutive series of five primary procedures on patients with painful plantar fibroma and seven revision operations on patients with recurrent plantar fibroma. The average follow-up was 47 months (range, 22-66 months) in the primary group and 40 months (range, 21-78 months) in the revision group. The overall results were satisfactory in four of the five primary operations, with only one recurrence. In the revision group, five of seven results were satisfactory with no recurrences. The major complication that led to unsatisfactory results was the development of a postoperative neuroma. In this article, we outline our present surgical techniques of wide primary excision and a staged revision procedure with delayed split-thickness skin graft closure. These techniques can be used successfully to manage this disabling, progressive disease.
PMID: 8563922 [PubMed - indexed for MEDLINE]
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