Plantar Fibromatosis. Wow, that's a mouthful! What is it? A lump in your arch that is firm and doesn't move. They usually start out as a very small pea sized nodule that increases in size over time. Most people don't even notice them until they get big enough to be annoying in your shoes or when walking barefoot. They can happen to anyone, but are most commonly seen in middle-aged to older patients and are much more common in men than woman. It is also more common in the Caucasian population than other ethnicities.
Most people come into the office complaining of a painful lump in their arch and are very concerned it is cancer. It is actually just an exuberant growth in the plantar fascia (a.k.a. the ligament that holds up your arch) or extra fibrous tissue. We really don't know why they occur, but it is thought that some kind of trauma plays a role in the formation of the nodules. I often see them in pilots and runners who have constant repetitive trauma to this area. Family history is also a factor. As many as 50% of patients with plantar fibromas also have nodules in the palm of their hands known as Dupuytren's contractures. There has been some correlation with medications like beta-blockers and anti-seizure medications. One study even linked an excessive amount of vitamin C with fibrous disorders. Patients with a history of chronic liver problems, diabetes, seizures and alcohol abuse seem to have a higher rate of plantar fibromas.
Treatments vary, but fall into three categories:
- Do nothing: the nodules are annoying but usually self-limiting. They do not grow indefinitely, so if you can put them down as life's minor annoyance, most patients choose to just leave them alone.
- Conservative or Non-invasive: Vigorous stretching, accommodative orthotics, physical therapy, and topical transderamal Verapamil.
- Surgery: injections with a corticosteroid can be helpful to decrease the inflammation around the nodule, but if they are large and painful; most go on to surgical excision.
What should you do? A personal question, that only you, with the help of your doctor, can answer. In my opinion, if the nodule is small, leave it alone. If it is increasing in size, then it should be addressed. If the nodule is of moderate size, with no intrasubstance calcifications on x-ray, and is annoying; a three to six month trial of transdermal verapamil coupled with an accommodative orthotic and physical therapy can be helpful. If it meets these criteria and is a little soft, then a steroid injection may also help decrease the size. If the lesion is large, painful, or has intrasubstance calcifications on x-ray; then excision is most likely your best option. Simple excision is not enough with these lesions, removal of not only the lesion, but a large margin is necessary to decrease recurrence rates.
If you have a painful lump in your arch, seek the advice of your podiatrist. Help is only a phone call or mouse-click away!