What Is Plantar Fibroma?
A plantar fibroma is a lump on the bottom of the foot, on the foot arch. it is associated with a hereditary condition called Dupuytren’s Contracture, a condition that can affect both the hands and the feet.
Plantar fibromatosis, or plantar fibroma, is a fibrotic tissue disorder or wound healing disorder which is non-cancerous and characterised by the presence of excess collagen or fibrotic tissue. The most common symptoms of plantar fibromatosis are firm nodular masses that can be felt just under the skin on the bottom of the foot, and pain when standing or walking. Studies show that plantar fibroma is present most often in the middle aged and elderly population, although it can affect people of all ages. It has been shown that the incidence may be as high as 25% in the middle aged and elderly population and that the condition affects men approximately 10 times more often than women. People of white or northern European descents tend to be affected more than other ethnicities.
A plantar fibroma can be seen in just one foot, or both. The most common site is in the mid-arch area of the foot. It can vary in position on the foot arch, from being just in front of the heel to just behind the ball of the foot.
A plantar fibroma is usually painful but in some instances it is not painful initially, just an annoyance. However, with the passage of time it usually becomes more painful as it presses on surrounding structures.
Etiology (Cause) Of Plantar Fibroma
Other than the fact it is related to Dupuytren’s Contracture (a common affliction of the palm of the hands) and Peyronie’s disease (a scar tissue disorder that causes curvature of the penis) there is not much known about the etiology, or cause, ofplantar fibroma.
The most commonly accepted cause ofplantar fibroma is injury to the plantar fascia. When there is an injury to the plantar fascia that causes even a small tear, patients with a tendency for fibroma formation will start to see a small lump form in the area of injury. As previously stated, the initial pain of the injury may be a distant memory by the time the plantar fibroma starts to form.
Essentially, a plantar fibroma is scar tissue formation that occurs at the site of the plantar fascia tear. It continues gradually over time, until there is a firm mass over the entire site of injury in the fascia.
Signs and Symptoms of Plantar Fibroma
The signs ofplantar fibroma are often obvious, with a visible firm lump in the mass of the foot. The patient can often press on the area and feel pain. They often cause the patient pain when walking or standing. With patients who already have a tight plantar fascia, or those suffering from plantar fasciitis, the plantar fibroma can progress more rapidly. It can press on tendons, ligaments, muscles, blood vessels or nerves. It is usually the pressure on the nearby nerves that causes the most pain. When the nerve pressure continues for some time, inflammation of the nerve becomes more chronic.
When the chronic inflammation of the nerve arises, the pain is present even when the patient is sitting. In such cases of coexisting nerve pain the symptoms are generally more painful in the morning but as the day progresses, the nerve will become less painful as it becomes more compressed. When the patient sits later in the day, the nerve is temporarily decompressed and “comes back to life”. There can be tingling, burning, sharp, shooting, stabbing, electric sensations localised to the area or radiating up into the toes or back into the heel and ankle.
Conservative Treatment For Plantar Fibroma Includes;
- Changes in shoes to include more supportive sport shoes or walking shoes that have a softer footbed.
- Oral anti-inflammatories including over-the-counter medications such as Brufen can help acute flare ups.
- Prescription strength anti-inflammatories prescribed by your GP or doctor.
- Prescription Transdermal Verapamil gel, which can reduce scar tissue.
- Anti-inflammatory injections (cortisone-type medications) into the mass and surrounding areas to decrease the inflammation.
- Stretching exercises – this may worsen the problem as it stretches the area of tear.
- Massage includingtennis ball orfrozen water bottle massage of the arch – as with stretching this may worsen the problem.
- Taping or strapping of the foot, arch or ankle to reduce the pressure on the plantar fascia.
- Long term conservative treatment should include custom moulded functional orthotics. The orthotics should have an accommodation for the plantar fibroma, this is probably the best conservative treatment for plantar fibroma.
Surgery For Plantar Fibroma
Excision of the Plantar Fibroma
Excision of the fibroma often causes further trauma to the plantar fascia resulting in scar tissue formation and the potential for proliferation of further new plantar fibroma.
Removal of the entire Plantar Fascia
The plantar fascia plays a very important role in connecting the rear foot to the forefoot, and it’s removal often results in permanent instability and structural changes of the foot. The recovery time can be over a year.
Radiation treatment used for cancer treatments can be used to shrink fibroma however this treatment carries a risk of causingmalignancy (cancer) and can cause swelling and pain.
Plantar Fibroma Cryosurgery Treatment
Below are images of cryosurgery treatment of a plantar fibroma and an ultrasound scan showing the plantar fibroma location within the foot arch area of the foot.
Cryosurgery treatment is a process that involves freezing and shrinking the fibroma. It is a minimally invasive procedure that is performed using a wide gauge needle known as a cryoprobe and ultrasound imaging. The technique does not involve cutting of the plantar fascia, and as such reduces the risk of proliferation of fibroma or the risk of lateral foot instability associated with removing plantar fascia, which can lead to functional instability of the entire foot.
Another benefit of the cryosurgical approach to treatment ofplantar fibroma is the softening effect of the fibroma during the freezing process. This is caused by the established strong collagen cross bonds of the plantar fibroma being broken during the freeze-thaw process. In addition, the inflamed nerves underlying the plantar fibroma are treated simultaneously resulting in decreased pain almost immediately.
The pain from the fibroma typically decreases dramatically within the first 2-3 days after treatment. For most patients the plantar fibroma is visibly smaller in size within a matter of days, not weeks. Improvement will often gradually continue as the plantar fibroma decreases in size. Over the following months after treatment, many plantar fibroma completely resolve. Larger plantar fibroma will tend to take longer to completely resolve. Sometimes, these larger plantar fibroma do not completely resolve and can require further treatment.
Benefits of Cryosurgery for Plantar Fibroma Treatment
- Cryosurgery treatment is easily tolerated by patients and is performed under local anaesthetic in a clinic environment.
- There is minimal pain or swelling after treatment.
- Cryosurgery is a very effective way of treating nerve inflammation caused by plantar fibroma.
- Fast recovery time.
- Patients can resume work and sport within a week.
- Low rates of complications.
For more information on plantar fibroma and cryosurgery treatments, or to book a consultation, call The Barn Clinic on 0114 221 4780 today.