Plantar Fibromatosis Treatment & Management

  • Author: Firas G Hougeir, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jul 12, 2010
 

Medical Care

No medical care is effective in plantar fibromatosis, and reported success probably is due to the possible spontaneous involution of superficial plantar fibromatosis. Early treatments have included anti-inflammatory medication, orthotics, and physical therapy. Other modalities have included methotrexate and radiation after surgery.

For Lederhose disease, the intralesional injection of corticosteroids has been tried, but its usefulness is doubtful, and these injections may have some utility at only the initial stage.

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Surgical Care

For Lederhose disease, fasciectomy and excision of the fibrous tissue are the only possible treatments, if needed. Fasciectomy has been shown to reduce the rate of recurrences.[10]

For the other forms of plantar fibromatosis, surgery is the only therapeutic alternative. However, in infantile forms, physicians should evaluate the need for surgery before performing it.[11]

Many juvenile fibromatoses spontaneously regress, and biopsy may be performed to induce their involution. Some lesions can grow, and others can recur after excision that appears complete. Because tumor growth characteristics may be relatively important before surgery, physicians should consider the possibility of an expectant control.

Hamartomatous plantar fibromatosis does not regress spontaneously; therefore, surgical removal is appropriate.

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Activity

Modification of activity, the use of orthotics, and physical therapy have been used as therapeutic modalities for the treatment of plantar fibromatosis.

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Contributor Information and Disclosures
Author

Firas G Hougeir, MD  Staff Physician, Department of Dermatology, Mayo Clinic Scottsdale

Firas G Hougeir, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Jose M Mascaro, MD, MS  Chairman, Professor, Department of Dermatology, Hospital Clinic, University of Barcelona, Spain

Jose M Mascaro, MD, MS is a member of the following medical societies: American Dermatological Association, American Society of Dermatopathology, and International Academy of Pathology

Disclosure: Nothing to disclose.

Specialty Editor Board

Neil Shear, MD  Professor and Chief of Dermatology, Professor of Medicine, Pediatrics and Pharmacology, University of Toronto Faculty of Medicine; Head of Dermatology, Sunnybrook Women's College Health Sciences Center and Women's College Hospital, Canada

Neil Shear, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Clinical Pharmacology and Therapeutics, Canadian Dermatology Association, Canadian Medical Association, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey P Callen, MD  Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School of Medicine

Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and American College of Rheumatology

Disclosure: Amgen Honoraria Consulting; Abbott Honoraria Consulting; Electrical Optical Sciences Consulting fee Consulting; Celgene Honoraria Safety monitoring committee; GSK - Glaxo Smith Kline Consulting fee Consulting; TenXBioPharma Consulting fee Safety Monitoring committee

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. McPoil TG, Martin RL, Cornwall MW, Wukich DK, Irrgang JJ, Godges JJ. Heel pain--plantar fasciitis: clinical practice guildelines linked to the international classification of function, disability, and health from the orthopaedic section of the American Physical Therapy Association. J Orthop Sports Phys Ther. Apr 2008;38(4):A1-A18. [Medline].

  2. Wiedemann HR, Burgio GR, Aldenhoff P, Kunze J, Kaufmann HJ, Schirg E. The proteus syndrome. Partial gigantism of the hands and/or feet, nevi, hemihypertrophy, subcutaneous tumors, macrocephaly or other skull anomalies and possible accelerated growth and visceral affections. Eur J Pediatr. Mar 1983;140(1):5-12. [Medline].

  3. Montgomery E, Lee JH, Abraham SC, Wu TT. Superficial fibromatoses are genetically distinct from deep fibromatoses. Mod Pathol. Jul 2001;14(7):695-701. [Medline].

  4. Morrison WB, Schweitzer ME, Wapner KL, Lackman RD. Plantar fibromatosis: a benign aggressive neoplasm with a characteristic appearance on MR images. Radiology. Dec 1994;193(3):841-5. [Medline].

  5. Bancroft LW, Peterson JJ, Kransdorf MJ. Imaging of soft tissue lesions of the foot and ankle. Radiol Clin North Am. Nov 2008;46(6):1093-103, vii. [Medline].

  6. Scheler J, Rehani B, Percy T, et al. Increased F-18 FDG uptake on positron emission tomography/computed tomography imaging caused by plantar fibromatosis. Clin Nucl Med. Apr 2008;33(4):280-1. [Medline].

  7. Alman BA, Naber SP, Terek RM, Jiranek WA, Goldberg MJ, Wolfe HJ. Platelet-derived growth factor in fibrous musculoskeletal disorders: a study of pathologic tissue sections and in vitro primary cell cultures. J Orthop Res. Jan 1995;13(1):67-77. [Medline].

  8. DeBrule MB, Mott RC, Funk C, Nixon BP, Armstrong DG. Osseous metaplasia in plantar fibromatosis: a case report. J Foot Ankle Surg. Nov-Dec 2004;43(6):430-2. [Medline].

  9. Evans HL. Multinucleated giant cells in plantar fibromatosis. Am J Surg Pathol. Feb 2002;26(2):244-8. [Medline].

  10. van der Veer WM, Hamburg SM, de Gast A, Niessen FB. Recurrence of plantar fibromatosis after plantar fasciectomy: single-center long-term results. Plast Reconstr Surg. Aug 2008;122(2):486-91. [Medline].

  11. Wapner KL, Ververeli PA, Moore JH Jr, Hecht PJ, Becker CE, Lackman RD. Plantar fibromatosis: a review of primary and recurrent surgical treatment. Foot Ankle Int. Sep 1995;16(9):548-51. [Medline].

  12. [Guideline] American College of Radiology. ACR Appropriateness Criteria chronic foot pain. American College of Radiology. 2005.

  13. [Guideline] American College of Occupational and Environmental Medicine. Ankle and foot complaints. American College of Occupational and Environmental Medicine. 2004.

  14. Enzinger FM, Weiss SW. Fibrous proliferations of infancy and childhood. In: Soft Tissue Tumors. St Louis: Mosby; 1983.

 
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Superficial fibromatosis of the heel.
Juvenile aponeurotic fibroma.
Hamartomatous fibromatosis.
 
 
 
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