ConditionBones, joints & muscles
Plantar Fibroma
A plantar fibroma is a firm, benign nodule of fibrous tissue in the plantar fascia, the thick band running along the bottom of the foot, usually in the middle of the arch. It feels like a rubbery lump under the skin and may hurt when you stand, walk or wear tight shoes. When several nodules form, the condition is called plantar fibromatosis or Ledderhose disease, which is related to Dupuytren's contracture in the hand. Most are managed with cushioned insoles and footwear changes; surgery is reserved for painful, growing lumps.
Also called: Plantar fibromatosis, Ledderhose disease, plantar fascia nodule
At a glance
- What it is
- A benign fibrous nodule in the plantar fascia of the arch.
- Who gets it
- Adults, most often 30s to 60s; more common in men.
- Associations
- Dupuytren's contracture, knuckle pads, Peyronie's disease, diabetes, epilepsy medicines.
- Symptoms
- Firm lump in the arch, sometimes painful with walking or shoes.
- Treatment
- Soft orthotics and padding, steroid injections, shockwave therapy, radiation in selected cases, surgery.
When to get help
See a doctor within a day or two
- A foot lump that is growing quickly, very painful at rest, or larger than about 5 cm (2 in)
- A lump with redness, warmth, fever or an open sore
Book a routine appointment
- A new firm lump in the arch of the foot, to confirm the diagnosis
- A known plantar fibroma that is getting bigger or making walking difficult
- Lumps in both feet or in the palms as well
Usually safe to manage at home
- A small, stable, mildly tender arch lump already diagnosed, managed with cushioned insoles and supportive shoes
What it feels like
- a firm, rubbery lump in the middle of the arch, under the skin
- usually less than 2.5 cm (1 in) across, though it can grow
- painless at first, then sometimes sore with standing, walking or barefoot on hard floors
- it moves with the plantar fascia rather than freely under the skin
- may occur in one or both feet; several lumps suggest Ledderhose disease
Causes and risk factors
The exact cause is unknown. Fibroblasts (cells that make connective tissue) in the plantar fascia multiply abnormally. Associations include:
- family history and genetic tendency
- Dupuytren's contracture of the hand, knuckle pads and Peyronie's disease (together called fibromatoses)
- diabetes
- long-term use of some anti-seizure medicines
- liver disease and alcohol use
- possibly repeated minor injury to the plantar fascia
Plantar fibroma vs other foot lumps
| Lump | Features |
|---|---|
| Plantar fibroma | Firm, in the arch, attached to the plantar fascia |
| Ganglion cyst | Fluid-filled, often on top of the foot near a joint or tendon |
| Lipoma | Soft, doughy, movable fatty lump |
| Plantar fasciitis | Heel pain, especially first steps in the morning; no distinct lump |
| Morton's neuroma | Burning pain between the toes, not a visible lump |
| Soft tissue sarcoma | Rare; usually larger, deeper, growing; needs urgent evaluation |
See foot or toe lump or mass for more causes.
Diagnosis
A foot and ankle specialist or podiatrist usually diagnoses it by examination. Ultrasound confirms a solid nodule within the plantar fascia. MRI shows the size and extent, especially before surgery or when the lump is large or unusual. A biopsy is rarely needed, but may be done if features are atypical.
Treatment
Treatment aims to relieve pain rather than remove the lump, since fibromas often stay stable for years.
Non-surgical
- custom or off-the-shelf orthotics with a cut-out or soft pad that takes pressure off the lump
- cushioned, supportive shoes; avoid going barefoot on hard floors
- stretching of the calf and plantar fascia
- steroid injections to shrink a painful nodule temporarily
- extracorporeal shockwave therapy, which has some evidence for pain relief
- topical verapamil gel has been used, with limited evidence
- low-dose radiation therapy is used in some centers for progressive Ledderhose disease
Surgery
Surgery is considered when the lump is very painful, growing, or interferes with walking despite other treatment:
- local excision of the nodule has a high recurrence rate
- complete or partial removal of the plantar fascia lowers recurrence but can flatten the arch and has a longer recovery
Recovery often involves several weeks of limited weight bearing. Recurrence remains possible.
Outlook
Plantar fibromas are not cancer and do not spread. Many remain small and painless. Some grow slowly or new nodules appear over time. Good footwear and orthotics allow most people to stay active without surgery.
Frequently asked questions
What causes a lump in the arch of the foot?
A firm lump in the arch is most often a plantar fibroma, a benign growth in the plantar fascia. Other causes include ganglion cysts, lipomas and, rarely, soft tissue tumors. An ultrasound can confirm what the lump is.
Is a plantar fibroma cancerous?
No. A plantar fibroma is a benign growth that does not spread. However, any foot lump that is growing quickly, very large or painful at rest should be evaluated to rule out rare cancers such as sarcoma.
Will a plantar fibroma go away on its own?
Usually not, but many stay the same size for years and cause little trouble. Cushioned orthotics and supportive shoes control symptoms for most people. Some lumps slowly grow or new ones develop.
Should a plantar fibroma be removed?
Surgery is only recommended when the lump is very painful or affects walking despite non-surgical treatment, because removal carries a significant risk of recurrence and can affect the foot's arch. Discuss the risks and benefits with a foot and ankle specialist.
Sources
This guide was written from current patient and clinical guidance, including:
- American College of Foot and Ankle Surgeons (FootHealthFacts): Plantar fibroma
- American Academy of Orthopaedic Surgeons (OrthoInfo): Foot lumps
- National Organization for Rare Disorders: Ledderhose disease
- MedlinePlus: Foot pain
- American Podiatric Medical Association: Foot conditions