Plantar fibroma
PF represents not a single entity, but rather, a heterogeneous group of conditions with the common characteristics of plantar location and histologic features of mature collagen and fibroblasts with no malignant cytologic features. The term plantar fibromatosis (PF) is used for different conditions, as follows, the most common being: (1) a relatively common plantar equivalent of Dupuytren palmar contracture named Ledderhose disease (LD); (2) a more uncommon plantar superficial fibromatosis that, unlike deep fibromatosis (eg, abdominal, extra-abdominal, and visceral fibromatosis) generally has a less aggressive and recurrent tendency. In LD, as in Dupuytren contracture (DC), repeated trauma, long-term 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. Often, patients with LD also have other fibrosing conditions such as DC, knuckle pads, or induratio penis plastica. Heredity is also a clear factor in many patients. Superficial fibromatosis (SF) in a plantar location includes a variety of soft-tissue tumoral proliferations of fibroblasts. However, it has been shown that some forms are not due to fibroblast overgrowth but to myofibroblast proliferation; SF is more common in children and young adults than in older people. Diagnosis is made by clinical exam. Biopsy of the masses is not recommended. The act of biopsy may cause the fibroma to enlarge. When the mass is removed a definitive diagnosis is provided by examination by microscopic examination by a pathologist. Treatment consists of padding the area to reduce pressure. Functional foot orthotics will take the strain off of the plantar fascia ligament and sometimes cause the fibromas to shrink in size. Cortisone injections are of little value and may even stimulate the mass to enlarge or spread. Surgical excision of the mass requires removal of most of the plantar fascia. Simple excision of the mass without removal of the entire ligament generally results in recurrence of the mass. 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 and its effect on foot function. A recent review… Foot Ankle Int. 1995 Sep;16(9):548-51.
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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