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Plantar Fibromatosis (Plantar Fibroma)

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Plantar fibromas are benign, firm lumps that form within the plantar fascia — the thick band of connective tissue running along the arch of the foot. They may remain small and painless, or grow and cause discomfort when walking or wearing shoes. They are part of a condition known as plantar fibromatosis (Ledderhose disease).

Symptoms

• A firm, immovable lump in the arch of the foot
• Pain when walking or standing barefoot
• Discomfort or pressure when wearing shoes
• The nodule may increase in size or number over time

Diagnosis

Diagnosis is made on clinical examination with confirmation from ultrasound or MRI to assess the size and extent of the fibroma and exclude other causes of foot lumps.

Causes

• Genetic predisposition (may be linked to Dupuytren's contracture or Peyronie's disease)
• Repetitive trauma or micro-injury to the plantar fascia
• Possible association with certain medications such as anti-seizure drugs
• Exact cause is not fully understood

Non-Surgical Treatment

• Custom orthotics to offload pressure from the nodule
• Cushioned footwear with arch support
• Stretching and physiotherapy to reduce plantar fascia tension
• Topical treatments such as verapamil cream (limited evidence)
• Steroid injections — can reduce pain though often do not shrink the fibroma

Low-Dose Radiotherapy

In selected cases, localised low-dose radiotherapy may be considered to slow or stop progression of nodules and reduce pain, particularly in early or actively growing cases. This is most commonly used in specialist centres.

Plantar fibromas are usually slow-growing and non-cancerous. Regular monitoring and supportive footwear are often sufficient to maintain comfort. If symptoms change or worsen, reassessment with Mr Hester is advised.