- in Other Conditions by Defeetit
What is Plantar Fibroma? [& How to Treat]
To really understand what a Plantar Fibroma is, we first need to talk about what the Plantar Fascia is. The plantar fascia is a band of fibrous connective tissue that sits on the bottom of your foot. It starts at the heel, and it extends to the toes. This connective tissue acts as a supportive structure, which has fibers that run parallel to each other, providing tensile strength, and stabilizing the foot while walking, running, or doing any type of exercise.
When excess connective tissue forms from the plantar fascia tissue, it forms a sort of knot, and it appears as a lump on the bottom of the foot. This lump or knot of excess plantar fascia tissue is what is known as plantar fibroma.
Plantar fibroma appears most often in men, and during the 2nd to the 6th decade of life. The plantar fibroma is benign, very slow to grow, and only painful if it is on a weight bearing area of the foot. Walking or running can put pressure on the fibroma, and result in inflammation and pain.
What Causes Plantar Fibroma?
The cause of plantar fibroma is unknown, but there are several theories. Research shows that there may be a connection between fibromas and trauma. Injury or tears in the fascia cause excess fibrous scar tissue to form, causing the soft tissue nodules, or a plantar fibroma. Another study shows that plantar fibromas are genetically linked, or inherited; but the specific gene is yet to be found.
How is Plantar Fibroma Diagnosed?
Plantar fibromas do not heal on their own. They usually do get bigger, and if they are on a weight bearing surface, they can be very painful. It is important to go right away to your health care practitioner to be evaluated.
Your doctor will do a clinical exam to determine if it is in fact a plantar fibroma. Many doctors can identify a plantar fibroma by the look and feel of it. To make a more definite diagnosis, Xrays, an Ultrasound, and even an MRI may be done. An Diagnostic Ultrasound is starting to become a more widely used modality. It is less expensive and it will show accurately whether the “lump” or soft tissue mass is in fact a plantar fibroma. However, an Ultrasound cannot determine how deep the soft tissue mass is. To determine the extent of the lesion, or how deep or thick it is, an MRI needs to be done.
Once a diagnosis has been made, and it has been determined how big the fibroma is, the next step is the treatment.
How to Treat Plantar Fibroma?
The treatment depends on how big the plantar fibroma is, and how inflamed and painful it is. The goal of all treatment is to decrease pain and discomfort and to decrease the size of the fibroma, or to remove it all together if necessary.
1. Orthotics
If the fibroma is not vey big, and just starting to get painful, an orthotic, with a pad to off-load the fibroma, and alleviate the pain, is a good choice. The orthotic, with the special pad in place will take the pressure off the fibroma and help to decrease the pain and associated inflammation.
2. Physical Therapy
A newer approach pioneered by some practitioners is to use light therapy. Specific wavelengths of light are used, i.e. infrared light and red light to help to decrease the inflammation. This will thereby decrease the size of the fibroma as well as the pain.
Massage therapy has also been beneficial in some cases to decrease the pain and to help to break up the fibrous tissue nodule (plantar fibroma).
Stretching exercises that target the plantar fibroma, or plantar fibroma exercises, have also been used as a physical therapy modality. One important exercise is the standing calf stretch (stretching the calf as well as the Achilles tendon) which will stretch the plantar fascia, as they are all connected by fibrous tissue. Stretching helps the plantar fascia fibers to glide over each other, which helps to loosen up the “knot” making up the plantar fibroma tissue.
These exercises can and should be done at home on a daily basis. Many physical therapists will give an at home treatment exercise regimen that needs to be followed.
3. Injections
Steroid injections directly into the plantar fibroma has been shown to decrease the size and inflammation of the fibroma. However, an “Ultrasound guided injection” into the fibroma is essential, since steroid injections into the plantar fascia itself can result in a rupture or tear of the fascia. The injections should be given directly into the plantar fibroma only.
4. Surgery
The last treatment modality is surgical removal of the plantar fibroma. There are many complications with surgery. Some of the complications include:
- The development of painful scar tissue after removal of the plantar fibroma
- The incision on the bottom of the foot takes longer to heal, and for the entire fascia to heal completely, it usually takes 1-2 months. Failure for the wound to heal is another complication
- Another major complication is recurrence. The plantar fibroma has a significantly high recurrence rate, meaning that it can and does come back in many cases
- Other complications include infection, nerve injury, DVT (deep venous thrombosis or blood clot in the leg), a PE (pulmonary embolism or a blood clot in the lung)
Due to these many complications, surgical removal of a plantar fibroma should only be done as a last resort.
In Summary
Now that you have an understanding of what a plantar fibroma is, if you do happen to find a lesion or a lump on the bottom of your foot, whether it is painful or not, it is a good idea to have it examined by your health care practitioner.
The plantar fibroma will not just go away. It usually does get bigger, and although it is slow to develop, it is progressive and not treating it right away, could lead to a more aggressive treatment approach, such as surgery.
The first step is to have your foot examined by a doctor and understand what the diagnosis is. If caught early, the more conservative treatments, including orthotics, and physical therapy are much more effective.
