What Causes Plantar Fascial Fibromatosis?

Plantar fibromatosis can be caused by genetics, medications or repetitive trauma like running.

Plantar fibromatosis (Ledderhose disease) is a relatively rare fibrous knot (nodule) in the arch of the foot, embedded within the plantar fascia. The plantar fascia is a band of connective 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 and is a benign growth.

Symptoms of plantar fibromatosis include a noticeable lump in the arch of the foot. 

Characteristics of this mass include:

• Lump feels firm to the touch
• Lump may stay the same size or get larger over time 
• Additional fibromas may develop
• May or may not cause pain
  • When pain occurs, it is usually due to shoes pushing against the lump, or when walking or standing barefoot

The cause of plantar fascial fibromatosis is unknown. Some possible causes may include:

• Trauma to the plantar fascia
  • From injury to the bottom of the foot
  • Repetitive impact activities such as running 
• Genetics
  • Seen more commonly in people of northern European descent
  • Rare in people of Asian descent
• Certain medications/supplements
  • Beta-blockers 
  • Anti-seizure medications such as phenytoin 
  • Glucosamine/chondroitin
  • Large doses of supplemental vitamin C 
• Long-term alcohol abuse 

Plantar fibromatosis often occurs in patients who have other fibroproliferative disorders such as:

• Dupuytren disease (also known as palmar fibromatosis) 
• Keloids
• Peyronie’s disease

A higher rate of plantar fibromatosis has also been found among patients with certain conditions such as diabetes, chronic liver disease, and seizure disorders, but the possible connection is not well understood.

Plantar fascial fibromatosis is usually diagnosed with a physical exam. 

Other tests that may be used to confirm a diagnosis of plantar fascial fibromatosis include:

• Magnetic resonance imaging (MRI) 
• Biopsy 

Plantar fascial fibromatosis usually does not go away or get smaller without treatment but the condition is benign (noncancerous). 

Nonsurgical treatments for plantar fascial fibromatosis can help relieve pain but will not get rid of the mass and may include: 

• Corticosteroid injections to help shrink the nodule and relieve pain 
  • Relief may only be temporary 
  • Fibroma may gradually return to its original size
• Orthotic devices (shoe inserts) may help relieve pain by distributing the patient’s weight away from the fibroma
• Physical therapy methods can deliver anti-inflammatory medication into the fibroma without an injection

If the plantar fibroma causes significant pain or increases in size then surgery to remove the fibroma may be recommended. 

Complications of plantar fascial fibromatosis include:

• Pain or the presence of the lump may affect a patients' ability to stand or walk
• A high incidence of recurrence of fibromas
• Surgical complications 
  • Flattening of the arch 
  • Development of hammertoes
  • Painful scars
  • Wound opening 
  • Nerve entrapment