Knot in the arch of my foot

Non-Surgical Treatment Options

If the fibroma is only an apparent bump and does not cause pain, the physician will most likely place the patient under observation to keep tabs on the growth. If pain is involved, there are non-surgical treatments that may be tried to help reduce symptoms and allow the patient to continue quality of life. These include:

• Topical treatments an inhibit the growth of fibrous tissue
• Corticosteroid injections can temporarily reduce pain and decrease the size of the nodule
• Orthotic inserts can be worn inside of the shoes for comfort and cushioning
• Physical therapy can help to break up fibrous knots and reduce pain by increasing blood flow to the area

A combination of these methods along with over-the-counter pain relievers may be all that is necessary for a patient to enjoy ongoing relief.

Surgery

If a plantar fibroma does not improve with more conservative treatment, your podiatrist might consider surgery as an option. There are risks involved when cutting in or around the plantar fascia because this band of tissue provides support for the foot. Following the surgery, hammertoes or flattened arch may occur and require the use of orthotic devices for comfort and proper function of the foot. Complications of surgery can involve infection, nerve damage, a painful healed lump, or recurrence of plantar fibroma.

Recovery

Because of the location of the nodule, it can take anywhere from one to two months before a patient can return to regular activity.

What is the Plantar Fibroma?

A plantar fibroma is a fibrous knot (nodule) in the arch of the foot. It is embedded within the plantar fascia, a band of tissue that extends from the heel to the toes on the bottom of the foot. A plantar fibroma can develop in one or both feet, is benign (non-malignant), and usually will not go away or get smaller without treatment. Definitive causes for this condition have not been clearly identified.

Signs and Symptoms

The characteristic sign of a plantar fibroma is a noticeable lump in the arch that feels firm to the touch. This mass can remain the same size or get larger over time, or additional fibromas may develop.

People who have a plantar fibroma may or may not have pain. When pain does occur, it is often caused by shoes pushing against the lump in the arch, although it can also arise when walking or standing barefoot.

Diagnosis

To diagnose a plantar fibroma, the foot and ankle surgeon will examine the foot and press on the affected area. Sometimes this can produce pain that extends down to the toes. An MRI or biopsy may be performed to further evaluate the lump and aid in diagnosis.

Treatment Options

Non-surgical treatment may help relieve the pain of a plantar fibroma, although it will not make the mass disappear. The foot and ankle surgeon may select one or more of the following non-surgical options:

• Steroid injections. Injecting corticosteroid medication into the mass may help shrink it and thereby relieve the pain that occurs when walking. This reduction may be only temporary and the fibroma could slowly return to its original size.
• Orthotic devices. If the fibroma is stable, meaning it is not changing in size, custom orthotic devices (shoe inserts) may relieve the pain by distributing the patient’s weight away from the fibroma.
• Physical therapy. The pain is sometimes treated through physical therapy methods that deliver anti-inflammatory medication into the fibroma without the need for injection.

If the mass increases in size or pain, the patient should be further evaluated. Surgical treatment to remove the fibroma is considered if the patient continues to experience pain following non-surgical approaches.

Surgical removal of a plantar fibroma may result in a flattening of the arch or development of hammertoes. Orthotic devices may be prescribed to provide support to the foot. Due to the high incidence of recurrence with this condition, continued follow-up with the foot and ankle surgeon is recommended.

For more information on Plantar Fibromas, call Crystal Falls Foot + Ankle Specialists at 512.738.8896 now and schedule your appointment today!

1. Home
2. Common Foot Problems
3. Plantar Fibromatosis

Written By: Chloe Wilson BSc(Hons) Physiotherapy
Reviewed By: FPE Medical Review Board

Plantar Fibromatosis is a foot condition where a small nodule, a plantar fibroma, grows in the arch of the foot on the plantar fascia. 

A plantar fibroma is a benign growth i.e. non-cancerous, which tends to be slow growing and usually less than an inch in size.  

Plantar fibromatosis is often painless but, depending on the location and size of the nodules, it can start to cause foot arch pain when you are on your feet.

Other medical terms for plantar fibromatosis include Ledderhose Disease, after Georg Ledderhose who first identified the disease in 1894, Morbus Ledderhose and Plantar Fascial Fibromatosis.  It is a similar condition to Dupytren’s contracture which occurs in the hand causing flexion of the fingers. 

What Is Plantar Fibromatosis?

In plantar fibromatosis, thickenings develop in the plantar fascia, the thick band of fibrous tissue on the bottom of the foot.

The plantar fascia runs between the heel and the toes, helping to support the arches of the foot. 

The thickenings in the plantar fascia can end up forming small nodules, plantar fibromas, usually in the central or medial portions of the plantar fascia.  There may be one solitary nodule or a cluster of nodules may develop. Plantar fibromas are one of the most common causes of a lump on bottom of foot.

Ledderhose Disease is a relatively minor condition but can cause foot arch pain with weight bearing activities such as standing and walking. Plantar fibromatosis usually only affects one foot, but in 25% of cases, both feet are affected. It should not be confused with plantar fasciitis where there is inflammation and degeneration of the plantar fascia.

Plantar Fibromatosis Symptoms

Common symptoms of Ledderhose Disease include:

• Visible Nodule:The most common symptom of plantar fibromatosis is a small lump under the skin on the sole of the foot. These nodules tend to be on the inner side of the sole of the foot, at the highest point of the foot arch. 

  Plantar fibroma nodules are usually small in size, typically measuring less than one inch and feel firm to touch.  They may remain the same size, grow over time or more nodules may gradually appear forming a cluster.  The nodules can most easily be seen by dorsiflexing the foot – pulling the toes up.  The plantar fibroma growths remain permanently unless removed surgically, they don’t just spontaneously resolve.

• Foot Pain: Often plantar fascial fibromatosis is entirely painless, but as the lump grows it may start to cause problems. Foot pain from plantar fibromatosis tends to occur when there is pressure directly on the plantar fibroma nodule, either from prodding it, pressure from shoes or weight bearing through the foot when standing, walking or running
• Toe Stiffness:  As plantar fibromatosis progresses, it can cause thickening of the plantar fascia. This can result in contractures and tightness which cause the toes to bend, limiting toe movements, causing stiffness and making walking difficult.

Plantar fibromatosis may go undetected for years if it is not causing any pain.  

What Causes Ledderhose Disease?

The underlying cause of plantar fibromatosis is unknown but there are a number of factors which are thought to be linked with Ledderhose disease:

• Genetics: A family history of Ledderhose Disease or Dupuytren's Contracture in the hands are the strongest risk factor for developing plantar fibromatosis
• Gender: Plantar Fibromatosis is more common in men then women with a male:female ratio of 2:1
• Medical Conditions: Diabetes, epilepsy, liver disease and Peyronie’s disease are thought to be associated with increased risk of developing plantar fibroma
• Long-term Alcohol Consumption: is thought to increase the risk of developing Ledderhose Disease
• Repetitive Foot Trauma: it is thought that plantar fibromatosis may develop as a result of small tears in the plantar fascia. As the body tries to heal itself, it goes into overdrive, laying down too much new tissue which forms the nodules

Diagnosing Ledderhose Disease

Your doctor may be able to diagnose plantar fibromatosis through clinical examination. 

If there is any doubt, an MRI scan (Magnetic Resonance Imaging) is usually the imaging of choice as there are other conditions than present in a similar fashion, such as plantar fasciitis.

MRI tends to be more accurate than x-ray or ultrasound at diagnosing plantar fibromatosis, showing the full extent of the condition. 

Treating Plantar Fibromatosis

Plantar fibromatosis treatment usually involves a combination of the following:

• Observation: Asymptomatic nodules, i.e. those that aren’t causing any pain, will most likely just be monitored. The nodules will never disappear, but they may never cause any problems.
• Injections: Corticosteroid injections can help relieve the pain and are most effective in the early stages of plantar fibromatosis and when given under ultrasound guidance
• Orthotics:  Wearing shoe insoles or special padding can help to reduce the force through the nodules, making walking more comfortable
• Physiotherapy: Treatment such as exercises, ultrasound and shock wave therapy may help reduce plantar fibromatosis pain. 
• Radiotherapy: If the nodule is growing and active then radiotherapy can be used to shrink and soften the lump. Whilst it won't get rid of the plantar fibroma completely, it may help delay progression for a number of years
• Surgery: Surgery for plantar fibromatosis should only be considered when there have been prolonged high pain levels and resultant decreased activity levels over a number of months. 

You can find out loads more about each of these treatment options including the pros and cons of each in the Plantar Fibroma Treatment article.

Your Questions Answered

1. Can A Plantar Fibroma Go Away? Without treatment a plantar fibroma is unlikely to get smaller or go away. The symptoms of plantar fibromatosis will settle with treatment, but the fibroma itself will remain unless surgically removed.
2. Is Plantar Fibromatosis Cancerous? No, a plantar fibroma is not cancerous. It is simply a mass of fibrous tissue in the foot which is completely benign i.e. non-malignant.
3. Is Plantar Fibromatosis The Same Thing As Plantar Fasciitis? No, fibromatosis and fasciitis are different conditions. Plantar fibromatosis is when a nodule grows in part of the plantar fascia. Plantar fasciitis is when there is damage and inflammation to the plantar fascia.
4. Is Ledderhose Disease Painful? Some people with Ledderhose disease do not get any pain at all, and may be completely unaware of the plantar fibroma. As the fibroma grows however, it may start pushing on surrounding tissues and causing pain when there is any pressure through the foot.
5. How Common Is Plantar Fibromatosis? Plantar Fibromatosis is a relatively rare disease which affects less than 1% of the population. This figure however rises to around 25% in people over the age of 65. Ledderhose Disease is 10 times more in common in men than women.
6. How Do You Stretch A Plantar Fibroma? You cannot stretch a plantar fibroma directly, but you can stretch the plantar fascia which it sits in. Rolling a golf ball or can underneath your foot is a great way to stretch out the area. Visit the plantar fascia stretches section to find out loads more. 
7. What Is The Plantar Fibromatosis ICD 10 Code? The 2021 icd 10 code for plantar fibromatosis is M72.2.
8. What Else Could It Be? There are lots of other things that can cause a lump underneath the foot other than plantar fibromas e.g. Morton's Neuroma, plantar warts and piezogenic paules - you can find out all about the in the Bottom Of Foot Lumps section.

What Else Can Help

You can find out loads more about the different treatment and prevention options in the Treatment For Plantar Fibroma article.

There are a number of other conditions that can cause pain in the bottom of the foot.  If plantar fibromatosis isn’t sounding quite like your problem, visit the foot arch pain page in the diagnosis section for help working out what may be causing your problem. 

Page Last Updated: 09/15/22
Next Review Due: 09/15/24

Related Articles

References

1. The Journal of Clinical and Aesthetic Dermatology - Ledderhose Disease: An Unusual Presentation. D. Fausto de Souza, L. Micaelo, T. Cuzzi and M. Ramos-e-Silva. September 2010

2. American Journal of Surgery - Incidence and treatment of recurrent plantar fibromatosis by surgery and postoperative radiotherapy. de Bree E, Zoetmulder F, Keus R, Peterse H and van Coevorden F. January 2004

3. Foot & Ankle Specialist Journal - Plantar Fibromatosis: Pathophysiology, Surgical and Nonsurgical Therapies: An Evidence-Based Review. Carroll P, Henshaw R, Garwood C, Raspovic K, Kumar D

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