“It feels like I have a rock in my shoe and it’s driving me CRAZY!”
If you feel like you have a growing rock or pebble in the arch of your foot, it could be a plantar fibroma. We see these boring little annoyances often in our office and offer a variety of treatment options to meet your individual needs and lifestyle.
A plantar fibroma (plantar fibromatosis or Ledderhose disease) is a benign (non-cancerous) growth within the large thick ligament of the foot, the plantar fascia. The primary function of the plantar fascia is to maintain the longitudinal plantar arch of the foot. Plantar fibromas affect primarily those in their middle age, although several cases have been described in children under 16 years of age, and even as young as 9 months. Men are more often affected than women and both feet can be affected ~25% of the time.
Nobody knows exactly why fibromas occur, but we do know that you have done nothing to cause it, and you could not have prevented it. They may appear concomitantly with similar conditions of other areas, such as Dupuytren’s disease in the hands, Peyronie’s disease in the penis, or keloid formation more generally. Other associated conditions include frozen shoulder, alcohol addiction, diabetes, epilepsy, smoking, repeated trauma, and long-term phenobarbital use. One recent study has suggested a possible genetic predisposition to plantar fascial disorders, including fibromas.
Even though they often don’t cause pain or limitation, they may become a bother when they become around 1cm in diameter. Then they can be aggravated by restrictive shoes, direct pressure on the mass, walking barefoot, standing for long periods of time, and how your foot uniquely moves with each step (biomechanics). Multiple fibromas may develop over time and can contribute to increased pain and limitations, scar formation, and even tissue contracture.
Some tests may be helpful is further characterizing your suspected plantar fibroma like ultrasound, MRI, and even biopsy to verify that you actually have a plantar fibroma and not something else like a malignancy (very rare).
There are more treatments for suspected plantar fibromas in the medical research than patients and many medical professionals realize. These treatments all vary in their methods, success rates, side effects, availability, insurance coverage, and timeline of treatment. The treatments in the scientific literature (alone or in combination) include, but are not limited to:
1. watchful waiting by patient and medical professionals regularly
2. offloading pads with orthotics with cutouts
3. steroid injections- 5 injections administered 4 weeks apart
4. verapamil- cream twice a day for 9 months, or 5 injections administered 2 weeks apart
5. radiation- weekly dose for 5 to 11 weeks
6. extracorporeal shock wave therapy- twice a week for 6 weeks
7. tamoxifen- an antiestrogen pill taken for several months
8. collagenase- 1 injection administered 4 weeks apart for several months
If your individualized conservative treatments fail to meet your goals of minimizing pain and maximizing function after adequate time, then removal of “the rock” may be needed. Your foot will tell you if it’s satisfied or not, you just have to listen to it! There is always a risk of reoccurrence with fibromas, but this risk can be minimized with proper surgical principles and techniques.
We urge you to discuss your concerns with your doctor and seek out a specialist who sees plantar fibromas frequently, will listen to you and answer all your questions, and often has had success with fibroma conservative therapies, therefore avoiding the risks and hassle of surgery.
If I can answer any questions you may have, feel free to reach out by calling (626) 821-9323.
Dr. Charles J. Hastings, DPM, FACFAS, FFPM RCPS(Glasg)