What Is Plantar Fibroma?

Plantar fibromatosis is a benign (noncancerous) condition that affects the plantar fascia, which is the thick band of tissue that runs along the bottom of the foot, connecting the heel to the toes. In this condition, nodules or lumps develop within the plantar fascia, causing pain and discomfort.¹

Causes of plantar fibroma

The exact cause of plantar fibroma still remains unknown, but there are several factors that can contribute to their development.¹ These include:

• Genetic factors: Certain genetic factors may play a role in the development of plantar fibromas as it has been observed that the condition tends to run in families
• Trauma or injury: Injury or trauma to the plantar fascia can trigger the development of plantar fibromas. This can include repetitive stress or microtrauma to the foot, such as from activities like running, jumping, or standing for long periods.
• Abnormal foot mechanics: People with abnormal foot mechanics, such as flat feet (pes planus) or high arches (pes cavus), may be more prone to developing plantar fibromas. These structural abnormalities can put excessive strain on the plantar fascia, increasing the risk of fibroma formation.
• Medical Conditions: Health conditions like diabetes, epilepsy, liver disease and Peyronie’s disease are thought to be associated with an increased risk of developing plantar fibroma
• Age and gender: Plantar fibromas tend to occur more frequently in middle-aged individuals, with the peak incidence between the ages of 40 and 60. They also appear to be more common in those assigned male at birth (AMAB) than those assigned female at birth (AFAB)

Signs and symptoms of plantar fibroma

 Here are some common signs and symptoms of plantar fibroma:

• Lump or nodule: Plantar fibromas usually present as a small, firm mass or nodule that can be felt beneath the skin on the bottom of the foot. The size of the lump may vary, ranging from a few millimetres to a centimetre or more.
• Pain or tenderness: The fibroma can cause pain or tenderness at the site of the lump. The pain is often localized to the arch area and may be worse when walking, standing, or applying pressure on the foot.
• Difficulty wearing shoes: Wearing certain types of shoes, especially those with a tight or narrow toe box, may become uncomfortable or painful. The lump may press against the shoe, causing discomfort or irritation.
• Changes in gait or walking pattern: To avoid putting pressure on the affected area, individuals with plantar fibromas may alter their gait or walking pattern. This can lead to changes in the way they walk, potentially causing discomfort or strain in other parts of the foot.
• Gradual growth: Plantar fibromas tend to grow slowly over time. The size of the lump may increase gradually, causing a more noticeable prominence in the arch of the foot.

Diagnosis of plantar fibroma

To diagnose a plantar fibroma, a healthcare professional, typically a podiatrist or orthopaedic specialist will perform the following:^1,2

• Medical history: The doctor will ask you about your symptoms, including any pain or discomfort you may be experiencing, as well as any relevant medical conditions or previous foot problems
• Physical examination: The doctor will physically examine your foot, looking for any lumps or nodules that may be present. They may also evaluate the range of motion in your foot and test for tenderness in the affected area.
• Imaging tests: In some cases, the doctor may recommend imaging tests to confirm the diagnosis. These can include X-rays, ultrasound, or magnetic resonance imaging (MRI) scans. These tests can help visualize the fibroma and rule out other conditions that may cause similar symptoms.
• Biopsy: In certain situations where the diagnosis is uncertain or if there is a possibility of a malignant (cancerous) growth, the doctor may perform a biopsy. This involves taking a small sample of tissue from the fibroma for laboratory analysis. A biopsy can help confirm the diagnosis and determine if any further treatment is necessary.

Management and treatment for plantar fibroma

The management and treatment options for plantar fibroma typically depend on the severity of symptoms and the impact on daily activities. Here are some common approaches:^1,2

Observation

If the plantar fibroma is small and not causing significant discomfort, your doctor may recommend a "watch and wait" approach. Regular monitoring of the fibroma may be advised to track any changes in size or symptoms.

Conservative treatments

Several non-surgical interventions can help manage the symptoms of plantar fibroma. These may include:

• Orthotic devices: Custom-made shoe inserts/pads or orthotic devices can provide support, redistribute pressure, and reduce the strain on the affected area
• Physical therapy: Stretching exercises and physical therapy modalities such as ultrasound or iontophoresis may be recommended to alleviate symptoms and improve flexibility
• Footwear modifications: Wearing shoes with a roomy toe box, low heel, and adequate arch support can reduce pressure on the fibroma and alleviate discomfort
• Non-steroidal anti-inflammatory drugs (NSAIDs): Over-the-counter pain medications like ibuprofen or naproxen can help reduce pain and inflammation

Corticosteroid injections

In some cases, corticosteroid injections may be administered directly into the fibroma to reduce inflammation and alleviate pain. However, this treatment option carries a risk of plantar fascia rupture and may not be suitable for all patients.

Extracorporeal shock wave therapy (ESWT)

This non-invasive procedure uses sound waves to stimulate healing and break down the fibrous tissue of the plantar fibroma. ESWT has shown promising results in some cases, but its effectiveness may vary.

Surgery

If conservative treatments fail to provide relief or if the fibroma is significantly impacting mobility and quality of life, surgical excision may be considered. The surgical procedure involves removing the fibroma from the plantar fascia. However, it's important to note that surgery carries potential risks, such as nerve damage or recurrence of the fibroma. 

Complications of plantar fibroma

Here are some potential complications associated with plantar fibromas:¹

• Pain: Plantar fibromas can cause pain and tenderness in the affected area, especially when standing, walking, or wearing shoes. The pain may be localized to the site of the fibroma or radiate to other parts of the foot
• Difficulty walking: The presence of plantar fibromas can make it difficult to walk or bear weight on the affected foot. The growths can interfere with the normal functioning of the foot, leading to an altered gait or limping
• Foot deformity: In some cases, plantar fibromas can cause the arch of the foot to flatten or collapse, leading to a condition called pes planus or flatfoot. This can result in further foot pain and instability
• Restricted range of motion: As plantar fibromas grow and increase in size, they can limit the normal range of motion of the foot and toes. This can affect activities that require bending or flexing of the foot, such as climbing stairs or participating in sports
• Compression of nearby structures: Plantar fibromas can compress nearby nerves, blood vessels, and other soft tissues. This compression can lead to symptoms such as tingling, numbness, or a sensation of pins and needles in the foot
• Recurrence: After surgical removal or other treatments, plantar fibromas tend to recur. This recurrence may be due to incomplete removal of the fibroma or the development of new fibromas over time

FAQs

How can I prevent plantar fibroma?

You cannot prevent plantar fibroma completely but you can reduce your risk of developing it by wearing comfortable shoes with good arch support and avoiding excessive pressure on the soles of your feet. Stretch your plantar fascia regularly and exercise daily. 

How common is plantar fibroma?

It is believed to be fairly uncommon, with estimates suggesting that it may affect around 1-2% of the general population.

Who gets plantar fibroma?

Plantar fibromas primarily affects adults, especially those between the ages of 40 and 60, and individuals who frequently engage in activities that put stress on their feet, such as athletes or individuals with occupations that require prolonged standing or walking and AMABs are twice as like to get plantar fibroma than AFABs.

Who is at risk of plantar fibroma?

Individuals who frequently engage in high-impact activities, such as athletes or dancers, as well as those with a family history of plantar fibromas, are at higher risk for developing this condition characterized by benign nodules in the arch of the foot.

When to see a doctor?

You should consider seeking medical attention from a healthcare professional if you experience persistent foot pain, the development of a noticeable lump or nodule in the arch of your foot, or if your foot's range of motion is significantly affected.

Summary

Plantar fibromatosis is a benign condition affecting the plantar fascia, causing nodules and pain in the foot. The exact cause remains unknown, but factors like genetics, trauma, abnormal foot mechanics, certain medical conditions, age, and gender contribute to its development. Plantar fibroma is estimated to affect 1-2% of the general population, primarily adults aged 40-60, with a higher incidence in AMAB individuals. Common symptoms one can experience include palpable lumps, localized pain, discomfort while wearing shoes, altered gait, and gradual growth of fibromas. Seek medical attention for persistent foot pain or noticeable lumps in the foot's arch. Your healthcare provider will diagnose your condition based on your medical history, physical examination, imaging tests, and, in uncertain cases, biopsy. Management varies based on symptom severity, ranging from observation to conservative treatments like orthotics, physical therapy, and NSAIDs. Other options include corticosteroid injections, extracorporeal shock wave therapy, and surgery, though surgery carries potential risks. Complications you might face include pain, difficulty walking, foot deformity, restricted motion, compression of nearby structures, and recurrence.