Diagnostic Considerations

Also consider the following:

Scar and keloid
Sarcoma
Fasciitis
Neurofibroma
Achromic neuroid nevus and malignant melanoma
Serous tendinous cyst
Mucoid cyst
Calcinosis
Osteoma and calcaneus spur
Gout

Clinically, Ledderhose disease can be confused with posttraumatic neuroma. However, Ledderhose disease is usually bilateral, although one side may be more prominent than the other. Clear cell sarcoma must be considered when MRI findings lead to the diagnosis of Ledderhose disease.

Superficial plantar fibromatosis must be distinguished from the other types of fibromatoses (eg, juvenile aponeurotic fibroma, aggressive infantile fibromatosis), but, even histologically, this identification is often not easy. Other conditions that may mimic superficial plantar fibromatosis are deep granuloma annulare, calcinosis, mucoid cyst, and Darier-Ferrand dermatofibrosarcoma (dermatofibrosarcoma protuberans). Granuloma annulare usually involves more than one element. Calcinosis and osteoma feel harder than superficial plantar fibromatosis and are easily visible on radiographs. Mucoid cysts are renitent. They grow relatively slowly, and their sizes vary; however, the differences in size are seen on a weekly, not necessarily daily, basis. Darier-Ferrand dermatofibrosarcoma usually involves pigmented overlying skin and has a slower evolution. In any case, biopsy is necessary to confirm the diagnosis.

Hamartomatous plantar fibromatosis must be distinguished from neurofibroma, neurofibromalike melanocytic nevus, and melanoma arising in a neurofibromalike nevus. The correct diagnosis can be obtained only with microscopic examination.

Workup

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Lindhurst MJ, Sapp JC, Teer JK, et. al. A mosaic activating mutation in AKT1 associated with the Proteus syndrome. N Engl J Med. 2011 Aug 18. 365 (7):611-9. [QxMD MEDLINE Link].
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. 1983 Mar. 140(1):5-12. [QxMD MEDLINE Link].
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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. 2008 Apr. 33(4):280-1. [QxMD MEDLINE Link].
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Media Gallery

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

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Author

Amanda T Moon, MD Clinical Assistant Professor of Dermatology, Children's Hospital of Philadelphia

Amanda T Moon, MD is a member of the following medical societies: American Academy of Dermatology, Society for Pediatric Dermatology, Women's Dermatologic Society

Disclosure: Nothing to disclose.

Coauthor(s)

Alexander Valiga Drexel University College of Medicine

Alexander Valiga is a member of the following medical societies: American Medical Association, Society for Melanoma Research, Tau Beta Pi Engineering Honor Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Dermatologic/Mohs Surgeon, The Surgery Center at Plano Dermatology

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

Disclosure: Received income in an amount equal to or greater than $250 from: Biogen US (Adjudicator for study entry cutaneous lupus erythematosus); Priovant (Adjudicator for entry into a dermatomyositis study); IQVIA (Serono - adjudicator for a study of cutaneous LE) <br/>Received honoraria from UpToDate for author/editor; Received royalty from Elsevier for book author/editor; Received dividends from trust accounts, but I do not control these accounts, and have directed our managers to divest pharmaceutical stocks as is fiscally prudent from Stock holdings in various trust accounts include some pharmaceutical companies and device makers for these trust accounts for: Stocks held in various trust accounts: Allergen; Amgen; Pfizer; 3M; Johnson and Johnson; Merck; Abbott Laboratories; AbbVie; Procter and Gamble;; Celgene; Gilead; CVS; Walgreens; Bristol-Myers Squibb.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

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

Disclosure: Nothing to disclose.

Additional Contributors

Firas G Hougeir, MD Staff Dermatologist, Private Practice, Georgia

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

Disclosure: Nothing to disclose.

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: Canadian Medical Association, Ontario Medical Association, Royal College of Physicians and Surgeons of Canada, Canadian Dermatology Association, American Academy of Dermatology, American Society for Clinical Pharmacology and Therapeutics

Disclosure: Nothing to disclose.

Acknowledgements

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.

Plantar Fibromatosis Differential Diagnoses

Diagnostic Considerations

References

Tables

Contributor Information and Disclosures

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