Plantar Fibromatosis

Plantar Fibromatosis is a common soft tissue mass found in the foot and one of the most common lesions found on the sole of the foot. It is a locally aggressive idiopathic proliferative fasciitis of the plantar aponeurosis or subcutaneous thickening of the plantar fascia. It is usually bilateral and frequently seen in children and young adults. In older people it is often associated with Dupuytren's contracture of the palmar fascia of the hand. The basic microscopic pathology of Dupuytren's contracture and plantar fibromas is about the same. The causes are obscure, but trauma does not play an important role. The disease usually occurs in adult males after 40 years. A relatively small number of cases are bilateral. Whether these tumors are familial is not clear, although cases have been recorded in multiple members of a family. Compared with palmar fibromatosis, the plantar variety is rare, although the exact incidence is not known, since a large number of theses cases are not reported. The lesion was described by Dupuytren, and later it was described in more detail by Ledderhose.

In Allen and Woolner's series of 69 cases, 35% were 30 years of age or younger, including two cases that were present at birth. Among 200 consecutive cases, which were reviewed at the Armed Forces Institute of Pathology between 1960 and 1978, 111 (55%) occurred in patients 30 years or younger. Of the 11 cases, 22 were children 10 years or younger. Aviles et al., reported that 77% of their cases were encountered in patients older than 45 years. Zamora et al., Journal of Hand Surgery, 1994 showed that there is an increase in transforming growth factor beta in the early phase of Dupuytren's contracture and Plantar Fibromatosis.

As far as clinical findings are concerned, the lesion (plantar fibroma) appears as a firm, single, subcutaneous thickening or nodule that adheres to the skin and is located in the middle and medial portion of the sole of the foot. It may be asymptomatic, but it may cause mild pain after long standing or walking.

Locke has classified plantar fibromatosis as proliferative(increased fibroblasts and cellular activity), active(nodules are formed), and residual(decreased fibroblastic activity).

One should consider surgery if there is pain and a change in the course of the lesion (increase in size, contracture).

Surgical incisions may be linear, S-shaped or zig-zag. The surgeon needs to perform a wide excision of the mass. The patient should try to remain non-weight bearing for 3 weeks if possible.

Some complications are recurrence, nerve entrapment, skin slough, scarring, hematoma, and arch fatigue. Simple excision appears to be a poor method of treatment. Allen et al. noted recurrences in 15 of 28 patients treated by simple excision. Patients who underwent local excision had a 57% incidence of recurrence at the excision site, whereas those who underwent side excision (fasciectomy) with or without skin graft had a more favorable result (8% recurrence).