Plantar Fibromatosis aka Ledderhose Disease - Foot Pain Explored (2023)

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Written By: Chloe WilsonBSc(Hons) Physiotherapy
Reviewed By:FPE Medical Review Board

Plantar Fibromatosis aka Ledderhose Disease - Foot Pain Explored (1)

Plantar Fibromatosis is a foot condition where a small nodule, a plantar fibroma, grows in the arch of the foot on the plantar fascia.

A plantar fibroma is a benign growth i.e. non-cancerous, which tends to be slow growing and usually less than an inch in size.

Plantar fibromatosis is often painless but, depending on the location and size of the nodules, it can start to causefoot arch painwhen you are on your feet.

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Other medical terms for plantar fibromatosis include Ledderhose Disease, after Georg Ledderhose who first identified the disease in 1894, Morbus Ledderhose and Plantar Fascial Fibromatosis. It is a similar condition to Dupytren’s contracture which occurs in the hand causing flexion of the fingers.

What Is Plantar Fibromatosis?

In plantar fibromatosis, thickenings develop in the plantar fascia, the thick band of fibrous tissue on the bottom of the foot.

Plantar Fibromatosis aka Ledderhose Disease - Foot Pain Explored (2)

The plantar fascia runs between the heel and the toes, helping to support the arches of the foot.

The thickenings in the plantar fascia can end up forming small nodules, plantar fibromas, usually in the central or medial portions of the plantar fascia. There may be one solitary nodule or a cluster of nodules may develop. Plantar fibromas are one of the most common causes of a lump on bottom of foot.

Ledderhose Disease is a relatively minor condition but can cause foot arch pain with weight bearing activities such as standing and walking. Plantar fibromatosis usually only affects one foot, but in 25% of cases, both feet are affected. It should not be confused withplantar fasciitiswhere there is inflammation and degeneration of the plantar fascia.

Plantar Fibromatosis Symptoms

Common symptoms of Ledderhose Disease include:

Plantar Fibromatosis aka Ledderhose Disease - Foot Pain Explored (3)

  • Visible Nodule: The most common symptom of plantar fibromatosis is a small lump under the skin on the sole of the foot. These nodules tend to be on the inner side of the sole of the foot, at the highest point of the foot arch.

    Plantar fibroma nodules are usually small in size, typically measuring less than one inch and feel firm to touch. They may remain the same size, grow over time or more nodules may gradually appear forming a cluster. The nodules can most easily be seen by dorsiflexing the foot – pulling the toes up. The plantar fibroma growths remain permanently unless removed surgically, they don’t just spontaneously resolve.

  • Foot Pain:Often plantar fascial fibromatosis is entirely painless, but as the lump grows it may start to cause problems. Foot pain from plantar fibromatosis tends to occur when there is pressure directly on the plantar fibroma nodule, either from prodding it, pressure from shoes or weight bearing through the foot when standing, walking or running
  • Toe Stiffness:As plantar fibromatosis progresses, it can cause thickening of the plantar fascia. This can result in contractures and tightness which cause the toes to bend, limiting toe movements, causing stiffness and making walking difficult.
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Plantar fibromatosis may go undetected for years if it is not causing any pain.

What Causes Ledderhose Disease?

The underlying cause of plantar fibromatosis is unknown but there are a number of factors which are thought to be linked with Ledderhose disease:

  • Genetics:A family history of Ledderhose Disease or Dupuytren's Contracture in the hands are the strongest risk factor for developing plantar fibromatosis
  • Gender: Plantar Fibromatosis is more common in men then women with a male:female ratio of 2:1
  • Medical Conditions:Diabetes, epilepsy, liver disease and Peyronie’s disease are thought to be associated with increased risk of developing plantar fibroma
  • Long-term Alcohol Consumption: is thought to increase the risk of developing Ledderhose Disease
  • Repetitive Foot Trauma:it is thought that plantar fibromatosis may develop as a result of small tears in the plantar fascia. As the body tries to heal itself, it goes into overdrive, laying down too much new tissue which forms the nodules

Diagnosing Ledderhose Disease

Your doctor may be able to diagnose plantar fibromatosis through clinical examination.

If there is any doubt, an MRI scan (Magnetic Resonance Imaging) is usually the imaging of choice as there are other conditions than present in a similar fashion, such as plantar fasciitis.

MRI tends to be more accurate than x-ray or ultrasound at diagnosing plantar fibromatosis, showing the full extent of the condition.

Treating Plantar Fibromatosis

Plantar fibromatosis treatment usually involves a combination of the following:

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  • Observation: Asymptomatic nodules, i.e. those that aren’t causing any pain, will most likely just be monitored. The nodules will never disappear, but they may never cause any problems.
  • Injections:Corticosteroid injections can help relieve the pain and are most effective in the early stages of plantar fibromatosis and when given under ultrasound guidance
  • Orthotics:Wearing shoe insoles or special padding can help to reduce the force through the nodules, making walking more comfortable
  • Physiotherapy:Treatment such as exercises, ultrasound and shock wave therapy may help reduce plantar fibromatosis pain.
  • Radiotherapy:If the nodule is growing and active then radiotherapy can be used to shrink and soften the lump. Whilst it won't get rid of the plantar fibroma completely, it may help delay progression for a number of years
  • Surgery: Surgery for plantar fibromatosis should only be considered when there have been prolonged high pain levels and resultant decreased activity levels over a number of months.

You can find out loads more about each of these treatment options including the pros and cons of each in the Plantar Fibroma Treatment article.

Your Questions Answered

  1. Can A Plantar Fibroma Go Away? Without treatment a plantar fibroma is unlikely to get smaller or go away. The symptoms of plantar fibromatosis will settle with treatment, but the fibroma itself will remain unless surgically removed.
  2. Is Plantar Fibromatosis Cancerous? No, a plantar fibroma is not cancerous. It is simply a mass of fibrous tissue in the foot which is completely benign i.e. non-malignant.
  3. Is Plantar Fibromatosis The Same Thing As Plantar Fasciitis?No, fibromatosis and fasciitis are different conditions. Plantar fibromatosis is when a nodule grows in part of the plantar fascia. Plantar fasciitis is when there is damage and inflammation to the plantar fascia.
  4. Is Ledderhose Disease Painful?Some people with Ledderhose disease do not get any pain at all, and may be completely unaware of the plantar fibroma. As the fibroma grows however, it may start pushing on surrounding tissues and causing pain when there is any pressure through the foot.
  5. How Common Is Plantar Fibromatosis?Plantar Fibromatosis is a relatively rare disease which affects less than 1% of the population. This figure however rises to around 25% in people over the age of 65. Ledderhose Disease is 10 times more in common in men than women.
  6. How Do You Stretch A Plantar Fibroma?You cannot stretch a plantar fibroma directly, but you can stretch the plantar fascia which it sits in. Rolling a golf ball or can underneath your foot is a great way to stretch out the area. Visit the plantar fascia stretches section to find out loads more.
  7. What Is The Plantar Fibromatosis ICD 10 Code? The 2021 icd 10 code for plantar fibromatosis is M72.2.
  8. What Else Could It Be? There are lots of other things that can cause a lump underneath the foot other than plantar fibromas e.g. Morton's Neuroma, plantar warts and piezogenic paules - you can find out all about the in the Bottom Of Foot Lumps section.

What Else Can Help

You can find out loads more about the different treatment and prevention options in the Treatment For Plantar Fibroma article.

There are a number of other conditions that can cause pain in the bottom of the foot. If plantar fibromatosis isn’t sounding quite like your problem, visit the foot arch pain page in the diagnosis section for help working out what may be causing your problem.

Page Last Updated: 09/15/22
Next Review Due: 09/15/24

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References

1. The Journal of Clinical and Aesthetic Dermatology - Ledderhose Disease: An Unusual Presentation. D. Fausto de Souza, L. Micaelo, T. Cuzzi andM. Ramos-e-Silva. September 2010

2. American Journal of Surgery -Incidence and treatment of recurrent plantar fibromatosis by surgery and postoperative radiotherapy. de Bree E,Zoetmulder F,Keus R,Peterse H and van Coevorden F. January 2004

3. Foot & Ankle Specialist Journal -Plantar Fibromatosis: Pathophysiology, Surgical and Nonsurgical Therapies: An Evidence-Based Review. Carroll P, Henshaw R, Garwood C,Raspovic K,Kumar D

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FAQs

Is Ledderhose disease painful? ›

Though Ledderhose disease is rare, it can be very painful and frustrating. You may notice changes in the way you walk. If you experience long-lasting pain in your feet, notice growths on the bottom of your feet or have difficulty straightening your toes, talk to your healthcare provider.

What does plantar fibroma pain feel like? ›

You'll likely notice this pain for the first time when wearing shoes that put pressure on the plantar fibroma under your skin. Depending on how big it is, a plantar fibroma can cause pressure on your foot. It might feel like there's a stone in your shoe, but when you try to shake it out, there's nothing there.

What happens if plantar fibroma is left untreated? ›

Over time, the inflammation and stress to the plantar fascia can result in small tears in the fascia. This will cause your pain levels to increase gradually and if left unaddressed, these tears might grow in size and number, making the plantar fascia more vulnerable to rupture and debilitation.

What is the best treatment for plantar fibroma? ›

Treatment for a Plantar Fibroma
  • Steroid injections. Putting corticosteroid medication into the nodule may help it shrink it, which will reduce or relieve the pain. ...
  • Shoe inserts. If your doctor determines the nodule is not growing anymore, they may suggest using custom shoe inserts. ...
  • Stretching. ...
  • Physical therapy.
13 Apr 2021

Should I get my plantar fibroma removed? ›

Unlike plantar warts, which grow on the skin, these grow deep inside on a thick fibrous band called the plantar fascia. When non-surgical measures for treating plantar fibromas, such as orthotics have failed to provide adequate relief of symptoms, surgical removal is a reasonable option.

Is plantar fibroma a disability? ›

A disability rating of 10 percent is warranted for each foot separately due to the veteran's service-connected plantar fibroma.

Can plantar fibromas turn cancerous? ›

On rare occasions, they can become malignant. Plantar fibromas: Plantar fibromas are tumors that grow on the plantar fascia, which is the tendon that runs the length of the bottom of the foot. If they become painful, they might require surgery.

Should you massage plantar fibroma? ›

Massaging your plantar fibroma is a conservative approach to managing the condition. It can potentially break up accumulated fibroma tissue, reduce tenderness, and make walking less painful. When massaging your foot, start slowly and gently. Also, avoid direct pressure on the nodule as this can make it more painful.

What is inside a plantar fibroma? ›

Plantar fibroma is a nodule that forms on the bottom of the foot in the arch area. This fibrous knot grows within the plantar fascia tissue that runs along the bottom of the foot, running from heel to toes. The nodule is made up of the same type of tissue that is found in ligaments.

Should I see a podiatrist with a plantar fibroma? ›

If you suspect you may have a plantar fibroma, see your podiatrist. They will be able to assess and differentiate a fibroma from other conditions such as a cyst, granuloma or a potential malignancy.

What doctor treats plantar fibroma? ›

A Podiatrist is a specialist that patients often see for plantar fibromatosis; however, your internal medicine doctor or family practitioner can also diagnose the condition and offer you treatment options.

How big can plantar fibromas grow? ›

A plantar fibroma is a benign (non-cancerous) nodule that typically grows in the arch of the foot and usually appears between ages 20 and 60. It usually is slow-growing and often less than one inch in size. Some can grow faster and are considered plantar fibromatosis.

Are Compression Socks good for plantar fibroma? ›

Compression socks are considered good for plantar fasciitis as they reduce the mobility of your feet by providing support to arches and ankles. Thus your alignment gets improved, and feet tissues don't get stressed. They also help in preventing injuries due to exercising in bad posture.

What is the difference between plantar fibroma and plantar fibromatosis? ›

What is it? A plantar fibroma is a benign nodule that grows on the bottom of the foot that usually appears in the second through sixth decade of life. It is usually slow growing and measures less than an inch in size. More invasive, rapid-growing and multiplanar fibromas are considered plantar fibromatosis.

How long is recovery from plantar fibroma surgery? ›

Many patients return to shoes after 3 weeks although this may take longer (6-8 weeks). Between 3-8 weeks after surgery • The foot starts to return to normal and you can return to shoes. The foot may still be quite swollen especially at the end of the day.

Does apple cider vinegar help plantar fibroma? ›

Using Apple Cider Vinegar to Treat a Plantar Fibroma

When used, it can lead to the quick dissolution of the hardening tissue. You can soak a piece of tissue or towel in the vinegar and tape to the sole of the affected foot overnight, allowing time for absorption to take place.

How do you get rid of a plantar fibroma naturally? ›

Fibromas will not go away without treatment. Options include topical gels, injections, orthotics, exercises, and surgery. Home remedies, such as ice and elevation, can reduce pain.

Is plantar fasciitis the same as Ledderhose disease? ›

Plantar fasciitis and Ledderhose disease are conditions that affect the feet. Both are a major source of pain and discomfort, but they each have different symptoms and treatments.

How long do you have to stay off your foot after plantar fasciitis surgery? ›

Plantar Fascia Release Surgery Recovery

Patients who have traditional open surgery will be required to wear a boot for two to three weeks after surgery to keep weight off the foot and allow the tissues to heal properly.

Can a plantar fibroma cause nerve pain? ›

Increased foot pain when standing, walking, and exercising—The fibroma doesn't cause pain directly, but the nodule can press on a nerve causing pain, numbness, and tingling sensations. This becomes more pronounced when you put weight on the affected foot.

When is surgery needed for plantar fibroma? ›

If the mass increases in size or pain, the patient should be further evaluated. Surgical treatment to remove the fibroma is considered if the patient continues to experience pain following nonsurgical approaches. Surgical removal of a plantar fibroma may result in a flattening of the arch or development of hammertoes.

Is walking barefoot good for plantar fasciitis? ›

For people with healthy feet, plantar fasciitis is one of the biggest risk factors of going barefoot. Likewise, most podiatrists agree that people who already have plantar fasciitis should avoid going barefoot for long periods of time, especially on hard surfaces like concrete or wood floors.

Is heat good for plantar fibroma? ›

Heat can also loosen up the plantar fascia ligament, which can make stretching and massage more effective. But heat doesn't numb pain and may cause more swelling. Using heat therapy on its own isn't usually recommended for treating plantar fasciitis.

Is plantar fibroma painful to touch? ›

Plantar fibromatosis is often painless but, depending on the location and size of the nodules, it can start to cause foot arch pain when you are on your feet.

What does a plantar fibroma look like on MRI? ›

In plantar fibromatosis (Ledderhose disease), the common MRI appearance of plantar fibroma is a lobulated mass of low signal intensity on both T1- and T2-weighted sequences due to its fibrous nature (Fig. 5). In some instances, plantar fibroma may show high signal on fluid-sensitive sequences [4].

Is plantar fibroma surgery outpatient? ›

Fibromas are removed during a short, outpatient procedure, which is usually very effective at relieving the pain. Recurrence after surgery can occur.

Should you sleep in support socks? ›

“When you're lying down, you take away the effect of gravity. So there's no reason to wear compression socks when lying down or sleeping.” Compression socks shouldn't be uncomfortably tight. Still, it feels good to take them off and give your legs a break.

Why do the insteps of my feet hurt? ›

Pain in the top of your foot is often caused by exercising, especially if it involves running, kicking or jumping. It may also be caused by wearing shoes that are too tight and some conditions, like gout. Your symptoms might give you an idea of what's causing your pain.

Why do my insteps ache? ›

Pain in the arch of the foot can be caused by a number of underlying conditions. Plantar fasciitis is the most common, but other causes may include posterior tibial tendon dysfunction, cavus foot, and more. Arch pain is a common foot concern.

What causes painful insteps? ›

Pain in the bottom of your foot is often caused by exercise, such as running, wearing shoes that are too tight or a condition, such as Morton's neuroma. Some people also have a foot shape that puts extra pressure on the bottom of the foot. Hard or cracked skin or a verruca can also cause this type of pain.

How can I relieve the pain in my arch of my foot? ›

To treat it:
  1. Rest, ice, and elevate your foot.
  2. Wear stiff-soled shoes or foot pads to relieve pressure.
  3. Take pain relievers.
  4. If you're still in pain, talk to your doctor.
11 Jun 2021

Can shoes have too much arch support? ›

You can have too much arch support, or you can have arch insoles or orthotics that are too rigid, too flexible, or the arch positioning is incorrect.

Can orthotics make your feet worse? ›

Stress from orthotics can actually lead to weak ankles, feet or knees and cause additional foot pain. Furthermore, it's difficult to get relief from orthotic inserts that weren't made correctly. You may also suffer from sore muscles as your body attempts to adapt to the orthotics.

Can a plantar fibroma be cancerous? ›

A plantar fibroma is a benign (non-cancerous) nodule that typically grows in the arch of the foot and usually appears between ages 20 and 60. It usually is slow-growing and often less than one inch in size. Some can grow faster and are considered plantar fibromatosis.

What is the best painkiller for foot pain? ›

Oral analgesic medications such as acetaminophen (paracetamol) or aspirin are often the first line choice for quick relief of foot pain. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen are also often recommended and can help to reduce inflammation at the same time.

Why do my feet hurt even with arch support? ›

Your insoles may be hurting your feet because they're not the right arch height, are too rigid or too flexible, are not the right style for your footwear, or the arch placement isn't working for your feet. For insoles that don't hurt your feet, looking for ones that offer a choice of arch heights.

Why is my foot keep hurting? ›

Injury, overuse or conditions causing inflammation involving any of the bones, ligaments or tendons in the foot can cause foot pain. Arthritis is a common cause of foot pain. Injury to the nerves of the feet may result in intense burning pain, numbness or tingling (peripheral neuropathy).

How do I know if my foot pain is serious? ›

Seek immediate medical attention if you:

Have severe pain or swelling. Have an open wound or a wound that is oozing pus. Have signs of infection, such as redness, warmth and tenderness in the affected area or you have a fever over 100 F (37.8 C) Are unable to walk or put weight on your foot.

Can foot pain be related to heart problems? ›

Swelling: When heart failure happens, it can make fluid build-up in the body, causing feet and ankles to swell. This can also happen in other body parts, leading to rapid weight gain. Numbness and Pain: When these symptoms occur in the feet it can be an indication of peripheral artery disease.

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