plantar fibromatosis

Plantar fibromatosis is most frequently present on the medial border of the sole, near the highest point of the arch. The lump is usually painless and the only pain experienced is when the nodule rubs on the shoe or floor. The overlying skin is freely movable, and contracture of the toes does not occur in the initial stages.

File:Plantar fibroma on foot.jpg

The typical appearance of plantar fibromatosis on magnetic resonance imaging (MRI) is a poorly defined, infiltrative mass in the aponeurosis next to the plantar muscles.{{cite web |url=http://rad.usuhs.edu/medpix/tf_case.html?&imageid=11390&pt_id=4777&topic_id=3914&quiz=no#discuss |title=Plantar fibromatosis |work=MedPix |at=Case 4777 | vauthors = Curran VW |publisher=Dept of Radiology and Radiological Sciences, Uniformed Services University |access-date=2007-12-28 |archive-url=https://web.archive.org/web/20141106185445/http://rad.usuhs.edu/medpix/tf_case.html#discuss |archive-date=2014-11-06 |url-status=dead }}

Only 25% of patients show symptoms on both feet (bilateral involvement). The disease may also infiltrate the dermis or, very rarely, the flexor tendon sheath.{{cite web|url=http://www.wheelessonline.com/ortho/ledderhose_disease_plantar_fibromatosis|title=Ledderhose Disease: plantar fibromatosis|work=Wheeless' Textbook of Orthopaedics| vauthors = Van Der Bauwhede J |access-date=2007-12-28|archive-date=2019-02-01|archive-url=https://web.archive.org/web/20190201034706/http://www.wheelessonline.com/ortho/ledderhose_disease_plantar_fibromatosis|url-status=live}}

{{see also|Dupuytren's contracture#Risk factors and possible causes}}

The histological and ultrastructural features of Ledderhose and Dupuytren's disease are the same, which supports the hypothesis that they have a common cause and pathogenesis. As with Dupuytren's disease, the root cause(s) of Ledderhose's disease are not yet understood. It has been noted that it is an inherited disease and of variable occurrence within families, i.e. the genes necessary for it may remain dormant for a generation or more and then surface in an individual, or be present in multiple individuals in the same generation with varying degree.{{cite web|url=http://www.drgreene.org/body.cfm?id=21&action=detail&ref=649|title=Dupuytren's Contracture and Plantar Fibromatosis| vauthors = Greene A |access-date=2007-12-28|archive-url=https://web.archive.org/web/20080612130830/http://www.drgreene.org/body.cfm?id=21&action=detail&ref=649|archive-date=2008-06-12|url-status=dead}}

There are certain identified risk factors. The disease is more commonly associated with:

• A family history of the disease
• Higher incidence in males
• Palmar fibromatosis 10–65% of the time.
• Peyronie's disease
• Epilepsy patients
• Diabetes mellitus

There is also a suspected, although unproven, link between incidence and alcoholism, smoking, liver diseases, thyroid problems, and stressful work involving the feet.{{citation needed|date=September 2020}}

A combination of physical examination of the arch and plantar fascia, as well as ultrasound imaging by a physician is the usual path to diagnosis.{{citation needed|date=September 2020}}

An MRI (Magnetic Resonance Imaging) scan is usually the imaging of choice to determine between other possible conditions such as ganglion cysts. MRI tends to be more accurate than x-ray or ultrasound, showing the full extent of the condition.{{Cite web | vauthors = Wilson C | url=https://www.foot-pain-explored.com/plantar-fibromatosis.html | title=Plantar Fibromatosis aka Ledderhose Disease - Foot Pain Explored | access-date=2018-11-29 | archive-date=2019-02-04 | archive-url=https://web.archive.org/web/20190204022248/https://www.foot-pain-explored.com/plantar-fibromatosis.html | url-status=live }}

Although the origin of the disease is unknown, there is speculation that it is an aggressive healing response to small tears in the plantar fascia, almost as if the fascia over-repairs itself following an injury. There is also some evidence that it might be genetic.

In the early stages, when the nodule is single and/or smaller, it is recommended to avoid direct pressure to the nodule(s). Soft inner soles on footwear and padding may be helpful.

MRI and sonogram (diagnostic ultrasound) are effective in showing the extent of the lesion, but cannot reveal the tissue composition. Even then, recognition of the imaging characteristics of plantar fibromatoses can help in the clinical diagnosis.

Surgery of Ledderhose's disease is difficult because tendons, nerves, and muscles are located very closely to each other. Additionally, feet have to carry heavy load, and surgery might have unpleasant side effects. If surgery is performed, the biopsy is predominantly cellular and frequently misdiagnosed as fibrosarcoma. Since the diseased area (lesion) is not encapsulated, clinical margins are difficult to define. As such, portions of the diseased tissue may be left in the foot after surgery. Inadequate excision is the leading cause of recurrence.

Radiotherapy has been shown to reduce the size of the nodules and reduce the pain associated with them. It is approximately 80% effective, with minimal side effects.{{cite journal | vauthors = de Haan A, van Nes JG, Werker PM, Langendijk JA, Steenbakkers RJ | title = Radiotherapy for patients with Ledderhose disease: Long-term effects, side effects and patient-rated outcome | journal = Radiotherapy and Oncology | volume = 168 | pages = 83–88 | date = March 2022 | pmid = 35101465 | doi = 10.1016/j.radonc.2022.01.031 | publisher = Elsevier BV | url = https://pure.rug.nl/ws/files/238683396/Radiotherapy_for_patients_with_Ledderhose_disease_Long_term_effects_side_effects_and_patient_rated_outcome.pdf }}

Post-surgical radiation treatment may decrease recurrence. There has also been variable success in preventing recurrence by administering gadolinium. Skin grafts have been shown to control the recurrence of the disease.

Extracorporeal shock wave therapy (ESWT) has, in some cases, been reported to significantly reduce pain and improve walking ability in patients with plantar fibromatosis.{{cite journal | vauthors = Ding Y, Du X, Li Q, Zhang M, Zhang Q, Tan X, Liu Q | title = Risk perception of coronavirus disease 2019 (COVID-19) and its related factors among college students in China during quarantine | journal = PLOS ONE | volume = 15 | issue = 8 | pages = e0237626 | year = 2020 | pmid = 32790791 | pmc = 7427752 | doi = 10.1371/journal.pone.0237447 | doi-access = free }} Collagenase injection, FDA-approved for Dupuytren's contracture with favorable outcomes,{{cite journal | vauthors = Bilkiss M, Shiddiky MJ, Ford R | title = Advanced Diagnostic Approaches for Necrotrophic Fungal Pathogens of Temperate Legumes With a Focus on Botrytis spp | journal = Frontiers in Microbiology | volume = 10 | issue = 3 | pages = 1889 | year = 2019 | pmid = 31474966 | pmc = 6706232 | doi = 10.4055/cios.2019.11.3.332 }} showed no benefit in a reported case of plantar fibromatosis.{{cite journal | vauthors = Hammoudeh ZS | title = Collagenase Clostridium histolyticum injection for plantar fibromatosis (Ledderhose disease) | journal = Plastic and Reconstructive Surgery | volume = 134 | issue = 3 | pages = 497e–499e | date = September 2014 | pmid = 25158740 | doi = 10.1097/PRS.0000000000000433 }} Cryotherapy has also been reported as an effective treatment for Ledderhose disease, with an approximate 80% success rate and potentially lower recurrence than conventional surgery.{{cite book | vauthors = Spilken TL | chapter = Cryotherapy and Other Therapeutical Options for Plantar Fibromatosis | title = Dupuytren's Disease and Related Hyperproliferative Disorders: Principles, Research, and Clinical Perspectives | veditors = Eaton C, Seegenschmiedt MH, Nanchahal J | publisher = Springer | year = 2011 | pages = 401–407 | doi = 10.1007/978-3-642-22697-7_49 | isbn = 978-3-642-22696-0 }}

Cortisone injections, such as triamcinolone, and clobetasol ointments have been shown to stall the progression of the disease temporarily, although the results are subjective and large-scale studies far from complete. Injections of superoxide dismutase have proven to be unsuccessful in curing the disease while radiotherapy has been used successfully on early-stage Ledderhose nodules.{{cite web|access-date=2024-07-12|title=Ledderhose disease|url=https://www.dupuytren-online.info/ledderhose_literature.html|website=www.dupuytren-online.info}}Grenfell S, Borg M. "Radiotherapy in fascial fibromatosis: a case series, literature review and considerations for treatment of early-stage disease." J Med Imaging Radiat Oncol. 2014;58(5):641–647. {{PMID|24730457}}{{cite journal | vauthors = Heyd R, Dorn AP, Herkströter M, Rödel C, Müller-Schimpfle M, Fraunholz I | title = Radiation therapy for early stages of morbus Ledderhose | journal = Strahlentherapie und Onkologie | volume = 186 | issue = 1 | pages = 24–29 | date = January 2010 | pmid = 20082184 | doi = 10.1007/s00066-009-2049-x | publisher = Springer Science and Business Media LLC }}{{cite journal | vauthors = Schuster J, Saraiya S, Tennyson N, Nedelka M, Mukhopadhyay N, Weiss E | title = Patient-reported outcomes after electron radiation treatment for early-stage palmar and plantar fibromatosis | journal = Practical Radiation Oncology | volume = 5 | issue = 6 | pages = e651–e658 | date = 2015 | pmid = 26421835 | doi = 10.1016/j.prro.2015.06.010 }}

Topical verapamil is also used to treat plantar fibromatosis.{{cite journal | vauthors = Young JR, Sternbach S, Willinger M, Hutchinson ID, Rosenbaum AJ | title = The etiology, evaluation, and management of plantar fibromatosis | journal = Orthopedic Research and Reviews | volume = 11 | pages = 1–7 | date = 2018-12-17 | pmid = 30774465 | pmc = 6367723 | doi = 10.2147/ORR.S154289 | doi-access = free }}{{Cite web | vauthors = Downey MS, Hutchinson B | date = February 2013 |url=https://www.podiatrytoday.com/point-counterpoint-conservative-care-best-approach-plantar-fibromatosis|title=Point-Counterpoint: Is Conservative Care The Best Approach For Plantar Fibromatosis?|website=Podiatry Today|language=en|access-date=2020-02-10|archive-date=2020-09-30|archive-url=https://web.archive.org/web/20200930162417/https://www.podiatrytoday.com/point-counterpoint-conservative-care-best-approach-plantar-fibromatosis|url-status=live}}

• Fibromatosis
• Dupuytren's contracture
• Plantar fasciitis
• List of cutaneous conditions

{{Reflist}}

{{Medical resources

| DiseasesDB =

| ICD10 = {{ICD10|M|72|2|m|70}}

| ICD9 = {{ICD9|728.71}}

| ICDO =

| OMIM = 126900

| MedlinePlus =

| eMedicineSubj = derm

| eMedicineTopic = 874

| MeshID = D000071380

| Orphanet = 199251

| ICD11 = {{ICD11|FB51.Y}}

| GARDNum = 6873

| GARDName = Plantar fibromatosis

}}

{{Soft tissue disorders}}

{{Soft tissue tumors and sarcomas}}

{{Authority control}}

Category:Rare diseases

Category:Dermal and subcutaneous growths