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by Scholten A
(PF, Ledderhose disease, Morbus Ledderhose)

Definition

Plantar fibromatosis (PF) is a rare condition where hard lumps form in the arch of the foot. The lumps can grow and lead to pain and problems walking. Treatment can help manage symptoms.

Causes

PF is caused by overgrowth of thick, fibrous tissue at the arch of the foot. It is not clear why this happens. Genes and other health conditions may play a role.

Risk Factors

PF is more common in men and middle-aged people. However, it can also happen in women and younger people. Things that may raise the risk of PF are:

  • A family history of PF
  • Having similar conditions in other parts of the body, such as:
    • Dupuytren disease
    • Peyronie disease
  • Repeated foot trauma
  • Diabetes
  • Epilepsy and certain anti-seizure medicines
  • Liver disease
  • Alcohol use disorder
  • Smoking

Symptoms

The main symptom of PF is one or more slow growing lumps in the arch of the foot. There may be no pain at first. Pain may develop as the lump gets bigger. It may be difficult to wear shoes or walk. More lumps may develop over time.

Diagnosis

The doctor will ask about symptoms and past health. A foot exam will be done.

Tests may include:

  • Imaging, such as an ultrasound or MRI—to see what the lumps are
  • A biopsy of the lump—a sample of tissue is taken and tested to rule out other causes

Diagnosis will be based on the symptoms and test results.

Treatment

PF does not need to be treated unless it causes pressure or pain. In that case, the goal is to ease symptoms and shrink the lumps. Options may be:

  • Steroid injections—to lower inflammation and pain
  • Shoe adjustments or inserts—to ease pain
  • Experimental medicines, such as:
    • Verapamil cream—may decrease tissue thickening and inflammation
    • Tamoxifen—may help slow the growth of cells and shrink the lumps
    • Collagenase injections—may help break down the thick tissue

If these treatments do not help, other options are:

  • Radiation therapy—to slow the growth of cells and lumps (may be used with or after surgery)
  • Surgery to:
    • Remove the lumps
    • Remove the plantar fascia—a long band of tissue at the bottom of the foot

Follow up will be needed. Sometimes the lumps come back and need more treatment.

Prevention

There are no known steps to prevent PF.

RESOURCES

American Academy of Physical Medicine and Rehabilitation  http://www.aapmr.org 

OrthoInfo—American Academy of Orthopaedic Surgeons  http://orthoinfo.org 

CANADIAN RESOURCES

Ontario Podiatric Medical Association  http://www.opma.ca 

Orthogate  http://www.orthogate.org 

References

Dupuytren disease. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/dupuytren-disease. Accessed May 19, 2021.

Fuiano M, Mosca M, et al. Current concepts about treatment options of plantar fibromatosis: A systematic review of the literature. Foot Ankle Surg. 2019;25(5):559-564.

Peyronie disease. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/peyronie-disease-17. Accessed May 19, 2021.

Plantar fibroma. American College of Foot and Ankle Surgeons website. Available at: https://www.acfas.org/footankleinfo/Plantar%5FFibroma.htm. Accessed May 19, 2021

Plantar fibromatosis. Merck Manual Professional Version website. Available at: https://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/foot-and-ankle-disorders/plantar-fibromatosis. Accessed May 19, 2021.

Young JR, Sternbach S, et al. The etiology, evaluation, and management of plantar fibromatosis. Orthop Res Rev. 2019;11:1–7.

Revision Information

  • Reviewer: EBSCO Medical Review Board Nicole Meregian, PA
  • Review Date: 09/2021
  • Update Date: 09/22/2021