Plantar fibroma

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Case
A 43-year-old football coach presents with a three-month history of pain in the plantar aspect of his foot. This had progressively become worse over time and was not associated with any trauma. The pain was made worse by physical activity and was particularly bad when he wore football boots.

On examination there was a small, localised area of tenderness just distal to the medial calcaneal tuberosity. This was associated with a small area of palpable thickening.

Findings
X-ray images of the foot are normal. There is no calcaneal spurring or other abnormality. There is a focal area of heterogeneous echotexture and thickening seen in the plantar fascia which measures 13 x 6 x 11mm which was tender to probe palpation and demonstrates increased vascularity. This is approximately 2cm distal to the origin of the plantar fascia and the appearances are suggestive of a plantar fibroma.

Discussion
This case was successfully managed with careful footwear selection and an orthotic. The pain progressively improved over a two-month period. During this time, he was able to resume wearing football boots and normal physical activity. The mass is still present, and palpable, but is no longer tender.

Plantar fibromatosis (also known as Ledderhose disease), is a rare pathology involving the plantar fascia. It is characterised by disordered fibrous tissue proliferation and the formation of nodules. It has a similar aetiology to Dupuytren’s in the hand however in contrast to that condition, it is rare to develop a contracture. While the condition is benign it can cause pain, loss of function and decreased quality of life. It is bilateral in approximately 25% of patients and is up to ten times more common in men.

In most cases this condition can be diagnosed based on clinical findings and confirmed with the use of ultrasound imaging. The characteristic finding is of a firm, localised mass related to the plantar fascia. MRI scans can also be used when there is uncertainty about the diagnosis. In many cases the fibroma does not need any specific treatment. While it is unlikely to ‘disappear’ or resolve, in many cases it does not cause any symptoms. As this case illustrates, simple treatments like changing footwear or using an orthotic device can be very helpful. Other non-surgical treatments including corticosteroid injections, shock wave therapy and physiotherapy interventions should also be considered. If the mass increases in size or becomes more painful, surgical treatment (to remove the fibroma) can be considered.

Important notice
FIFA does not bear any responsibility for the accuracy and completeness of any information provided in the “Radiology Review” features and cannot be held liable with regard to the information provided or any acts or omissions occurring on the basis of this information.

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Morozan Aurel
06 December 2020 13:27

Very well explained. Easy for me as a physiotherapist to understand! thank you

Bakary M jarju
Bakary M jarju
07 December 2020 7:50

In most case this situation can be resolved by clinical trials

Phumi
08 December 2020 11:45

Very useful insights and images, thank you

Bangoura
Bangoura
15 December 2020 13:41

LE SIGNE PROMONITOIRE EST LA PRESENCE D UNE BOSSE DANS L ARCHE QUI EST FERME AU TOUCHER. CETTE MASSE PEUT S ACCROITRE EN TAILLE ET ENTRAINER DES FIBROMES SUPPLEMENTAIRES. CLINIQUEMENT LE PALPATION ENTRAINE LA DOULEUR JUSQU AUX ORTEILS ET NOUS EDIFIE POUR UN DIAGNOSTIQUE DE PRESOMPTION. L ECHOGRAPHIE ET L IRM SONT DES EXAMENS FIABLE EN IMAGERIE. TRAITEMENTS L INJECTION LOCALE DE CORTICOIDES POUR REDUIRE LA DOULEUR. SI LE FIBROME EST STABBLE SANS CHANGEMENT DE TAILLE ON FAIT RECOURS A UNE ORTHESE PLANTAIRE SUR MESURE. POUR TRAITEMENT CONSERVATEURS.. EN CAS D ECHEC AU X TRAITEMENTS CONSERVATEURS LA CHIRURGIE PREND PLACE… Read more »

Seyed MohammadJavad AshrafMansouri
04 January 2021 9:09

very well explained.thanks alot