While many of us will ignore worsening pain in our feet, it is pretty hard to ignore the fact that a bump that wasn’t there before has arrived. Painful bumps can occur almost anywhere on our feet, but when they arise in the arches of our feet they are almost always fibromas.
Fibromas are benign tumors that are comprised of dense fibrous connective tissue that can occur in the hand or in the arch of the foot. When they occur in the foot it is referred to as plantar facial fibromatosis or Ledderhose disease. The tumors will grow along the plantar facial band in the foot which is a tight band of connective tissue that runs from the heel to our toes. This band of tissue is like a string on a bow and helps maintain the bony arch of our feet. Unfortunately, due to genetic predisposition and sometimes injury, this band can become thickened leading to fibroma formation.
Fibromas appear like elevated lumps in the arch of our feet. They are typically firm in nature, however can be slightly soft to touch. This type of tumor will often become adherent to surrounding tissues, and the lesion usually feels like it is attached to adjacent skin. Over time, fibroma can become larger over the course of several years. Lesions usually do not grow much larger than 2 or 3 cm in size, but when this occurs, the increased pressure to mass can lead to increased pain. Increased pain is typically due to irritation to the nerve that underlies the lesion deeper in the foot.
Treatment options for fibroma are either conservative or surgical. Conservative treatment is usually recommended first as in most cases pain can be reduced, but in larger more painful lesions, surgery may be required.
Conservative Treatments include:
- Anti-inflammatory medications: these are especially used if the patient is experiencing an acute flare-up of pain.
- Injection therapy: injection of corticosteroid medication, also known as cortisone, directly into mass to reduce inflammation and pain as well as help break up abnormal connective tissue.
- Topical medications: Medications like transdermal Verapamil gel which helps break up collagen fibers that the fibroma is comprised of.
- Accommodative inserts and shoes: Selection of shoes that do not provide excessive pressure to site and custom orthotics that accommodate lesion and reduce pressure can be helpful.
Surgical treatment may be required if the lesion has become very large or conservative therapy has failed. Surgery involves resection of the mass as well as some healthy surrounding tissue to reduce the risk of recurrence. This procedure take less than an hour to perform and requires the patient to be non-weightbearing in post-op shoe or walking boot for 2-3 weeks until sutures can be removed, at which time walking is allowed. Total recovery time to return to full normal activity is typically about 8 weeks. After recovery, patients often require custom orthotics to help stabilize the foot since a large structural piece of tissue has to be removed.
It is IMPORTANT to note that while the majority of tumors of the foot are benign, malignancy can occur. Some simple things to look for that can indicate a cancerous mass are:
- Rapid growth of lesion
- Skin discoloration
- A wound forming over the mass (ulceration of skin)
- Rapid increase in pain at the site of the lump
- Similar lesions on the body besides your hands
If any of these changes are seen you should be seen by a physician immediately.
Fibromas can be effectively treated by your podiatric physician and the earlier treatment is administered the better the outcomes. If you suffer from a painful fibroma on your feet come see us at Foot and Ankle Associates of North Texas and we can help you get back to pain free steps and strides!