Is a condition that causes thickening of the deep connective tissue in the foot, known as the fascia. It is also characterised by slow growing fibrous non-malignant lumps which may sometimes invade the tendons and dermis of the skin, on the bottom of the foot.
Initially, plantar fascial fibromatosis may be quite minor causing little to no discomfort, but as the condition progresses it can lead to contraction thickening of the tendons. This can result in claw toes, making walking painful and difficult.
It is more prevalent in males, with patients typically presenting to a podiatrist more out of concern about the lump on the bottom of their foot, than pain. However, these growths can be painful as they grow in size.
The initial cause of plantar fascial fibromatosis is unknown. A similar disease is Dupuytren’s disease, which affects the hand and causes bent fingers.
Symptoms of Plantar Fascial Fibromatosis:
- Usually only affect one foot, with 25% of patients showing symptoms in both feet.
- Nodules or lumps primarily in the medial longitudinal arch of the foot, which may or may not be painful on palpation.
- Nodules may invade the skin of flexor tendon on rare occasions.
- The overlying skin is freely movable.
- Tightness of the fascia and possible contracture of the toes.
- On MRI infiltration masses can be seen within the fascial sheath.
Causes of Plantar Fascial Fibromatosis:
- The exact etiology is not well understood.
- Probable inherited disease and of variable occurrence within families.
- Possible healing response to small tears in the fascia, resulting from stressful work on the feet.
- Diabetes.
Treatment for Plantar Fascial Fibromatosis:
- In the initial stages when the nodules are small and singular in numbers removing pressure from the area with a soft insole is paramount.
- An orthotic will prevent the plantar fascia ligament from over stretching and can be customised to offload the nodules.
- The use of a night splint to stretch the plantar fascia and reduce the size of the fibroma.
- Supportive appropriate footwear to increase comfort levels.
- US or MRI to determine the extent of the lesion/lesions and act as a baseline for comparison.
- Biopsy should be considered to rule out malignancies.
- Cortisone injections will delay the progression of the disease but prolong use can cause tendon rupture.
- Surgery is difficult as the nodules borders are difficult to define. If pathological tissue is left in the foot after surgery, re-occurrence will occur. Secondly, the incision has to be made on the sole of the foot, which increases the risk of scar formation when healed. The patient may no longer have the fibroma but they may end up with a painful scar that hurts, just as much to walk.
- Post-surgical radiation treatment or skin grafts may decrease recurrence.
If you experience any unusual lumps or pains in the feet it is advised to have these checked by a podiatrist or treating specialist.
At Well Heeled Podiatry we are experienced in dealing with a range of conditions that cause arch and heel pain.
