11 Sep Plantar Fibromas – What Are They And How They Are Managed
A plantar fibroma is a benign nodule that grows on the bottom of the foot as a single mass or in a cluster. They commonly occur between the 20s and 60s. They are usually slow-growing and very small in size (subcentimeter). However, there is a condition where they occur as more invasive, and rapid-growing, known as plantar fibromatosis. These are both benign tumors and comprise of fibroblasts. On the other hand, plantar fasciitis involves an inflammation of the ligament that connects the heel of the foot to the base of the toes.
A plantar fibroma often occurs within a ligament in the arch of the person’s foot (aka plantar fascia). As the mass grows, it can cause discomfort and pain with walking. The exact cause of plantar fibromas is not known, but prior trauma and the use of phenytoin have been implicated. People with preexisting chronic conditions, such as diabetes mellitus, hypothyroidism, epilepsy, and cirrhosis of the liver are considered to be at higher risk of developing plantar fibromas.
The diagnosis of a plantar fibroma is made through a clinical examination. In most cases, a biopsy is not recommended because it can potentially enlarge the fibroma. Painful fibromas need to be surgically removed, and the surgical pathology typically reveals benign fibroblasts. In cases where the fibromas are not very painful, conservative management is employed, which includes padding the feet in order to reduce the pain and pressure. Foot orthotics may be used to provide relief to the plantar fascia area. In some cases, it might also be useful to wear a splint or night brace. Some patients benefit from cortisone injections are not recommended or useful and may be extremely painful. If these forms of treatment do not provide relief from the pain, surgical intervention to remove the plantar fibroma might be pursued.
Surgery should be considered a treatment of last resort because it has the potential to give rise to a number of complications. When a plantar fibroma is surgically removed, it is also required to remove most of the health plantar fascia ligament. This is because leaving the plantar fascia in place may lead to regrowth of the fibroma. The patient is strictly advised to keep the weight off the foot as the foot heals. They likely have to use crutches during this time. It will usually take close to 2 months the person is able to walk properly. If the surgery is more extensive owing to the increased size or number of fibromas, the tumor is large or there are multiples are more of them, the duration of post-surgical disability is longer, and the recovery may not be complete. An important question related to plantar fibroma is whether this condition is considered to be a disability. In cases where the plantar fibroma and the plantar fascia have been surgically removed, the patient is unable to stand for three to four weeks post-surgery.