Plantar Fibromatosis (Ledderhose Disease)

What plantar fibromatosis is

The plantar fascia supports the arch and runs from the heel to the toes. In plantar fibromatosis, cells called fibroblasts multiply and lay down excess collagen, forming firm nodules, usually in the middle to inner part of the arch. Nodules grow slowly, may come and go in activity, and can join together. Unlike Dupuytren's disease in the hand, plantar fibromatosis rarely causes the toes to curl.

Plantar fibroma vs plantar fibromatosis

A single nodule is often called a plantar fibroma; multiple or recurring nodules are called plantar fibromatosis. They are the same condition.

Causes and risk factors

The exact cause is unknown. Associated factors include:

• Dupuytren's contracture: many people with Ledderhose also have Dupuytren's; they share genetic factors.
• Peyronie's disease and knuckle pads (Garrod's pads), other related fibrosing conditions.
• Family history.
• Diabetes, epilepsy and anti-seizure medicines, liver disease and heavy alcohol use.
• Repetitive foot trauma may play a role.

Symptoms

• one or more firm, rubbery lumps in the arch that do not move much under the skin
• foot pain when walking, standing or pressing on the lump
• discomfort with tight or hard-soled shoes
• rarely, toe stiffness or contracture in advanced cases

Many lumps are painless.

Plantar fibromatosis vs plantar fasciitis

Diagnosis

A foot specialist (podiatrist or orthopedic foot and ankle surgeon) examines the foot and feels the nodules. Imaging confirms the diagnosis and rules out other lumps, such as ganglion cysts, lipomas or, rarely, soft tissue sarcomas:

• Ultrasound: shows a nodule within the plantar fascia.
• MRI: for larger, deep or unclear lumps, and for surgical planning.
• Biopsy: only if imaging is atypical.

Treatment

Non-surgical

• Soft orthotic insoles with a cutout or recess under the nodule to offload pressure.
• Cushioned, supportive shoes with soft soles.
• Stretching of the calf and plantar fascia.
• Anti-inflammatory pain relievers for flare-ups. Follow the label dose and avoid NSAIDs if you have kidney problems or stomach ulcers.
• Steroid injections into the nodule can reduce pain and size temporarily.
• Radiotherapy: low-dose radiation can reduce pain and slow growth in early, active disease; offered at some centers.
• Other treatments under study include collagenase injections, cryoablation and shockwave therapy.

Surgery

Surgery is considered for painful lumps that do not respond to other treatment. Options range from removing the nodule alone to removing most of the plantar fascia (fasciectomy). Recurrence is common, especially after limited excision, and wide removal lowers recurrence but has a longer recovery. Wound healing problems and painful scars can occur, so surgery is used cautiously.

Outlook

Plantar fibromatosis is benign and does not spread. Nodules may grow slowly, remain stable, or occasionally shrink. Most people control symptoms with footwear changes and orthotics.

Frequently asked questions

What is plantar fibromatosis?

It is a benign condition in which firm lumps develop in the plantar fascia, the band of tissue along the arch of the foot. It is also called Ledderhose disease and is related to Dupuytren's contracture of the hand.

Is plantar fibromatosis cancer?

No. Plantar fibromatosis is benign and does not spread. Doctors may use ultrasound or MRI to confirm the diagnosis and rule out rare cancerous foot lumps, especially if a lump is large or growing quickly.

What is the best treatment for plantar fibromatosis?

Most people do well with soft orthotics that relieve pressure on the lump and cushioned shoes. Steroid injections or radiotherapy can help persistent symptoms. Surgery is reserved for severe cases because lumps often come back.

Can plantar fibromatosis go away on its own?

Sometimes nodules stop growing or slightly shrink, but they usually do not disappear completely. Many people have stable, painless lumps for years without needing treatment beyond comfortable footwear.