Plantar Fibromastosis (lump in heel)

While foot problems affect a large portion of the population plantar fibromatosis remains a relatively uncommon diagnosis. It is a somewhat rare condition that occurs when plantar fibromas (non-cancerous/benign tumors) develop on the bottom of the foot within the connective tissues (plantar fascia) that run from the heel to the toe of the foot. These benign tumors are firm, slow growing masses that contain excessive collagen or fibrotic tissue levels. Plantar fibromatosis can develop in one or both feet and usually develops in concert with other issues, such as the use of anti-seizure medication Dilantin, or after damage has occurred to the plantar fascia. The reason for the connection between certain medications and the increased development in plantar fibromatosis has not been established.

When tumors initially develop on the plantar side of the foot they are usually small in the early stages of development and tend to not interfere with regular, healthy foot function. It is only when the masses increase in size that they make bending the toes increasingly difficult and therefore negatively impact the regular gait cycle and begin to cause discomfort. Symptoms are similar to those found with Dupuytren`s disease, a condition that affects the hands in much the same way that plantar fibromatosis affects the bottom of the feet.

Men are stricken with this condition ten times more often than women, and Caucasians are more affected than any other race. The development of plantar fibromas tends to increase with age; they most often develop in middle-aged or the elderly. Men over seventy years of age are particularly vulnerable. Superficial plantar fibromatosis, also called Ledderhose`s disease or Morbus Ledderhose, is more often diagnosed in children than adults. It strikes both feet (bilateral condition) in 25% of cases. Also found in the fibromatisis group are aggressive infantile fibromatosis (AIF) and juvenile aponeurotic fibroma (JAF), both of which may be present at birth.

Plantar Fibromatosis: Symptoms

While pain is a frequent symptom of plantar fibromatosis it is not always present when the growths, which are firm to the touch, initially appear on the arch of the foot. Pain symptoms are likely to occur as the mass increases in size. Some patients experience discomfort primarily when wearing shoes that increase pressure on the arch, or when they are barefoot. A variety of symptoms may be present according to the size, location, and type of fibroma that has developed.

Plantar Fibromatosis: Cause

While there is no clear underlying catalyst for the development of plantar fibromatosis many patients share one or more of the following traits:
• Patient is a Caucasian male 70 years of age or older
• There is a family history of this condition
• Patient suffers from epilepsy
• Patient has been diagnosed with diabetes mellitus
• Previous diagnosis of palmar fibromatosis
• Previous diagnosis of peyronie’s disease
• Excessive alcohol consumption
• Liver disease
• Thyroid problems
• Excessive standing or walking for extended periods of time
• The use of prescription medications such as Dilantin

While causation has never been clearly established trauma to the feet is thought to be a factor in the development of plantar fibromatosis, particularly in the form of micro-tears to the tissue or injuries such as puncture wounds.

As previously mentioned prescription medications such as Dilantin and the anti-seizure medication Phenytoin have been linked to fibrotic tissue disorders as well. Beta-blocker supplements such as glucosamine/chondroitin and large quantities of the Vitamin C supplement have been linked to the development of this condition as well, possibly because they enhance the production of collagen and aggravate fibrotic disorders. Patients suffering from this condition should inform their doctor of medications and/or supplements they may be taking as well as family and personal medical history. It should also be noted that 50% of patients being suffering from plantar fibromatosis also have Dupuytren’s Disease.

Plantar Fibromatosis: Diagnosis

Process of elimination is frequently used to diagnose plantar fibromatosis to ensure the patient is not suffering from post-traumatic neuroma, synovial sarcoma, epithelial sarcoma, inclusion body fibromatosis or fibrosarcoma. If there is any question as to the nature of the growth excision and biopsy of the mass will confirm a diagnosis. X-rays are usually taken as a prerequisite to advanced imaging studies but in this case they are not reliable enough to diagnose fibromas. Podiatrists instead rely on magnetic resonance imaging (MRI`s) to investigate fibromas and determine the shape, size and depth of the growth. It is not unusual for fibromas to reach the aponeurosis, the fibrous connective tissue that connects the muscle to the bone on the plantar side of the foot.

The patient`s medical history, family history, lifestyle, prescription drug intake, supplement intake and symptoms will also be considered when the diagnosis is being made.

Plantar Fibromatosis: Treatment

The size and location of the fibromas will dictate the course of treatment to be taken, as will the occurrence and/or severity of pain symptoms. Smaller fibromas causing minimal pain will usually be treated with orthotic devices that provide padding; night splints; heel lifts; or arch supports in order to reduce pressure on the growth. Reduced pressure has proven effective in shrinking the size of the fibromas. Verapamil gel (at a strength of 15%) is a calcium channel blocker that is used to treat heart problems such as angina and irregular heartbeat but has also proven effective in shrinking this type of tumor as well when applied to the mass twice a day.

Should the growths become painful and fail to respond to such treatments more invasive procedures such as cortisone injections and/or surgery may be pursued. While cortisone injections often help reduce pain they may also have the opposite effect and cause the spread and/or the enlargement of the fibroma. The fibroma can also be surgically removed but there is also the risk that it will recur at a later date. Surgical intervention is considered only in some cases and is typically performed as an out-patient procedure but under anesthesia. The use of crutches or a walker will be required for three to four weeks post-surgery.

Plantar Fibromatosis: Prevention

Preventing plantar fibromatosis is difficult because the underlying cause is often unclear. Early symptom recognition followed by immediate medical treatment will prevent the condition from worsening. There are, however, several steps that can be taken to improve overall foot health:

• Stretch the feet on a regular basis, particularly the plantar fascia (see Dr Foot Plantar Fasciitis Exercises).
• Maintain a healthy weight.
• Eat a varied, healthy diet.
• Remain hydrated through sufficient intake of fluids.
• Wear supportive footwear that protects your feet and provides adequate stability.
• Always wear activity-appropriate footwear.
• Warm up before all physical activity and cool down sufficiently afterward.
• Ease into new exercise routines.
• Rest your feet as often as possible; elevate after standing or walking for long periods of time.
• Visually and physically examine your feet for any changes or injuries you may not otherwise feel.

Conclusion

Plantar fibromatosis is an uncommon affliction with obscure etymology. There are, however, several steps that can be taken to ensure general foot health, and should symptoms arise professional medical advice should be pursued.