The etiology, evaluation, and management of plantar fibromatosis

Abstract

Plantar fibromatosis (Ledderhose disease) is a rare, benign, hyperproliferative fibrous tissue disorder resulting in the formation of nodules along the plantar fascia. This condition can be locally aggressive, and often results in pain, functional disability, and decreased quality of life. Diagnosis is primarily clinical, but MRI and ultrasound are useful confirmatory adjuncts. Given the benign nature of this condition, treatment has historically involved symptomatic management. A multitude of conservative treatment strategies supported by varying levels of evidence have been described mostly in small-scale trials. These therapies include steroid injections, verapamil, radiation therapy, extracorporeal shock wave therapy, tamoxifen, and collagenase. When conservative measures fail, surgical removal of fibromas and adjacent plantar fascia is often done, although recurrence is common. This review aims to provide a broad overview of the clinical features of this disease as well as the current treatment strategies being employed in the management of this condition.

Keywords: Ledderhose disease; plantar fascia; plantar fibromatosis.

Figure 1

Anatomy of the plantar fascia. Notes: Adapted from Gramatikoff.

Figure 2

Sagittal T2 MRI demonstrating a plantar fascia fibroma. Note: The fibroma has low-to-intermediate signal relative to muscle. (Reproduced with permission; Case courtesy of Radswiki, Radiopaedia.org, rID: 11776).

Figure 3

Plantar fibroma as seen on ultrasound. Note: Reproduced with permission; Case courtesy of Dr Chris O’Donnell, Radiopaedia.org, rID: 30471. Abbreviation: RT, right.