Understanding Plantar Fibromas and Ledderhose Disease: Treatment Options for Pain and Relief

Plantar fibromas are benign growths or nodules that form in the arch of the foot, specifically within the plantar fascia, which is the thick band of tissue that supports the arch. These fibrous masses, although non-cancerous, can cause discomfort and pain, especially when walking or standing. When these fibromas occur in the feet, the condition is referred to as plantar fibromatosis, which is also known as Ledderhose disease.

What Are Plantar Fibromas?

Plantar fibromas are typically overgrowths of scar tissue and present as firm, painless, or sometimes painful nodules in the arch of the foot. The exact cause is not always known, but they are thought to develop as a result of trauma, genetics, or other unknown factors. These masses are generally slow-growing and benign, meaning they are not cancerous.

The symptoms of plantar fibromas can vary from mild discomfort to significant pain, depending on their size and location. Patients often feel a noticeable lump under the skin of the foot, which can become tender with prolonged activity or pressure.

Diagnosing Plantar Fibromas

In clinical practice, diagnosing plantar fibromas is often straightforward based on the physical appearance and location of the nodule. In most cases, an MRI is not necessary to confirm the diagnosis unless the mass presents unusually or the patient has a concerning history, such as a history of malignancy. However, an MRI can be used to gain a more detailed look if needed.

As a leading podiatry textbook states, any soft tissue mass in the foot should be suspected of being cancerous unless proven otherwise, typically through a biopsy. That said, in the case of plantar fibromas, most podiatrists confidently diagnose and treat the condition based on clinical evaluation alone without the need for invasive procedures.

Why Surgery Isn’t Recommended

Although it may be tempting to surgically remove the fibroma, surgical excision is generally not recommended for plantar fibromas. This is because surgery can lead to excessive scarring—since scar tissue is part of the healing process—and there’s a significant risk of recurrence. The development of painful scar tissue after surgery can often lead to more discomfort than the original fibroma, making it a less desirable option for most patients.

My Approach: Shockwave Therapy and Enzyme Injections

In my practice, I favor non-invasive or minimally invasive treatments for plantar fibromas. Two of the most effective methods are shockwave therapy and enzyme injections.

  • Shockwave Therapy: This treatment uses acoustic waves to stimulate healing and reduce the size of the fibroma. Shockwave therapy can also help reduce pain and discomfort associated with the mass.
  • Enzyme Injections: Another highly effective option is enzyme injections, which specifically target the fibrotic tissue. Here’s how it works:
    • The area around the fibroma is anesthetized for comfort.
    • Using ultrasound guidance, I carefully examine the nodule to ensure precise targeting.
    • An enzyme, typically hyaluronidase, combined with other ingredients, is injected into the fibroma. This enzyme helps catalyze the breakdown of scar tissue, which can reduce the size of the mass.
    • Following the injection, patients often experience a reduction in pain and a softening of the fibroma over time.
  • Enzyme therapy has shown a good success rate for shrinking fibromas, and it avoids the complications associated with surgery. In some cases, I may also utilize topical verapamil cream or combine the injection therapy with shockwave therapy to enhance the results.

The Non-Invasive Advantage

The reason I emphasize non-invasive treatments, like enzyme injections, is because they work with your body’s natural processes to break down the fibrotic tissue without causing further scarring. Using hyaluronidase and other ingredients helps minimize the mass, offering relief from pain and discomfort while avoiding the risks associated with surgery.

Final Thoughts

While plantar fibromas can be bothersome, they are benign and can often be managed effectively without the need for surgical intervention. If you’re dealing with pain or discomfort due to a plantar fibroma, shockwave therapy or enzyme injections may offer a safe and effective solution. If you have concerns about a lump in your foot, I am here to help you determine the best course of treatment, ensuring minimal discomfort and optimal recovery.

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