Plantar Fibromatosis Differential Diagnoses

Updated: Jul 10, 2018
  • Author: Amanda T Moon, MD; Chief Editor: Dirk M Elston, MD  more...
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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.