I was out on placement in the hospital with the Orthotist, and a patient came in with this condition. Pain was only an issue on weight bearing (although rare), particularly in shoes with no support. There was a lump, which naturally, was of some concern to the patient. In doing weight bearing and footwear assessments, along with getting the patient’s social history, it was realised that the location of the lump attributed to the limited pain, as it was in the medial arch of the foot. Basically, that area is a low pressure one, and it is mainly ballet type shoes that contribute to pains, since they have no support. Given it was my first fibroma, I was eager to observe the patient’s stance and gait. With that done, the interesting part was determining the best solution for the patient, factoring in the social and footwear findings.
What is a Plantar Fibroma?
A plantar fibroma is a fibrous knot (nodule) in the arch of the foot. It is embedded within the plantar fascia, a band of tissue that extends from the heel to the toes on the bottom of the foot. A fibroma can develop in one or both feet, is benign (non-malignant), and usually will not go away or get smaller without treatment.
A precise cause for this condition have not been clearly identified, but doctors generally agree that the following could be potentially responsible:
Trauma to the plantar fascia is thought to be a primary cause. It may be from a puncture through the bottom of the foot, or from repetitive impact from activities such as running or climbing. It is also thought that thickening and tightening of the plantar fascia caused by plantar fasciitis, may lead to tears in the tissue, causing plantar fibromas to occur.
Many patients may be genetically predisposed to fibrotic tissue disorders such as this. People of northern European descent appear to have a higher incidence of fibrotic diseases, while they rarely affect Asians. People with plantar fibromas may also have a parent or a close relative with the condition.
Medications/ Vitamins/ Supplements
Medications often used for treating high blood pressure that belong to the drug class known as beta adrenergic blocking agents (beta-blockers), have been reported to cause fibrotic tissue disorders. Anti-seizure medications such as phenytoin, and certain supplements such as glucosamine/chondroitin and large doses of supplemental vitamin C may also promote the production of excess collagen.
Signs and Symptoms
The characteristic sign of a plantar fibroma is a noticeable lump in the arch that feels firm to the touch. This mass can remain the same size, or get larger over time, or additional fibromas may develop.
People who have a plantar fibroma may or may not have pain. When pain does occur, it is often caused by shoes pushing against the lump in the arch, although it can also arise when walking or standing barefoot.
To diagnose a plantar fibroma, the foot and ankle surgeon will examine the foot and press on the affected area. Sometimes this can produce pain that extends down to the toes. An MRI or biopsy may be performed to further evaluate the lump and aid in diagnosis.
Non-surgical treatment may help relieve the pain of a plantar fibroma, although it will not make the mass disappear. The foot and ankle surgeon may select one or more of the following non-surgical options:
Steroid injections – Injecting corticosteroid medication into the mass may help shrink it and thereby relieve the pain that occurs when walking. This reduction may be only temporary though, and the fibroma could slowly return to its original size.
Orthotic devices – If the fibroma is stable, meaning it is not changing in size, custom orthotic devices (shoe inserts), may relieve the pain by distributing the patient’s weight away from the it.
Physical therapy – The pain is sometimes treated through physical therapy methods, that deliver anti-inflammatory medication into the fibroma without the need for injection.
Prognosis for the future
If the mass increases in size or pain, the patient should be further evaluated. Surgical treatment to remove the fibroma is considered if the patient continues to experience pain following non-surgical approaches.
Surgical removal of a plantar fibroma may result in a flattening of the arch or development of hammertoes. Orthotic devices may be prescribed to provide support to the foot. Due to the high incidence of recurrence with this condition, continued follow-up with the foot and ankle surgeon is recommended.
Your feet mirror your general health . . . cherish them!