A plantar fibroma is a benign, fibrous growth located in the arch of the foot. This lump develops within the plantar fascia, a thick band of tissue spanning from the heel to the toes that supports the foot’s arch. While often small and initially painless, a fibroma can become noticeable as a palpable lump, sometimes causing discomfort or pain, especially with pressure.
Understanding Plantar Fibroma
A plantar fibroma is a firm nodule, typically less than an inch, that forms as a thickening of the plantar fascia in the arch of the foot. These growths can occur in one or both feet. Symptoms include pain or tenderness, especially when walking, standing for extended periods, or when external pressure is applied, such as from shoes.
While the precise cause is often unknown, genetics may play a role, with a higher incidence observed in people of Northern European descent. Trauma or repetitive injury to the foot, leading to tears in the fascia, is also considered a potential factor, though some experts debate its direct link. Diagnosis usually involves a physical examination where a healthcare provider will palpate the lump. Imaging tests like MRI or ultrasound can confirm the diagnosis and help rule out other conditions.
Non-Surgical Approaches
Non-surgical treatments are often the first line of defense against plantar fibroma symptoms, especially for mild to moderate cases. These methods aim to reduce pain and inflammation. While these approaches often manage symptoms effectively, they typically do not make the nodule disappear entirely.
Orthotics and arch supports can redistribute pressure across the foot, alleviating discomfort caused by the fibroma. Custom orthotics can be tailored to the foot’s specific shape, providing targeted support. Stretching and physical therapy exercises, such as calf stretches and arch stretches, can improve flexibility and reduce tension in the plantar fascia. These exercises can help strengthen the foot arch and make the foot more pliable, though their direct effect on fibroma size is limited.
Over-the-counter anti-inflammatory drugs (NSAIDs) can help manage pain and swelling associated with plantar fibromas. For more direct treatment, corticosteroid injections may be administered into the nodule to reduce inflammation and pain. While these injections can provide temporary relief and may shrink the fibroma, the growth might return to its original size over time.
Topical gels, such as transdermal verapamil 15 percent gel, are sometimes prescribed. This gel is believed to inhibit fibrous tissue growth and may reduce pain within a few months, potentially remodeling the affected tissue over a longer period. Extracorporeal shockwave therapy (ESWT) is another non-invasive option that uses sound waves to treat the condition. This therapy has shown promise in reducing pain and softening the nodules, though its ability to reduce the actual size of the fibroma is still being studied. Collagenase injections aim to break down collagen, potentially reducing the nodule’s size.
Surgical Solutions
Surgical intervention for plantar fibromas is generally considered when conservative treatments have not provided sufficient relief, or if the fibroma is particularly large, causing severe pain or functional limitations. The primary surgical procedure involves removing the fibroma. This can be done through open surgery, which typically involves making an incision to remove the growth and a portion of the plantar fascia.
Minimally invasive surgical techniques are also emerging, which may involve smaller incisions and potentially faster recovery times. Following surgery, the recovery process can vary, but typically involves a period of non-weight-bearing, often requiring a walking boot or crutches for several weeks to months. Full recovery, including a return to sports or physically demanding work, can take anywhere from six weeks to six months, depending on the extent of the surgery and individual healing.
However, surgical solutions carry risks. These can include infection at the surgical site, nerve damage that might lead to numbness or tingling, and scarring that could affect foot mechanics. A significant concern with surgery is the possibility of recurrence, where the fibroma may grow back even after successful removal.
Preventing Recurrence
Plantar fibromas can recur even after successful treatment. Therefore, ongoing strategies are important to minimize recurrence and manage any returning symptoms.
Continued use of custom orthotics can help distribute pressure evenly across the foot and provide support to the arch. Wearing supportive footwear that does not put undue pressure on the foot’s arch is also beneficial. Regular stretching exercises for the foot, ankle, and calf muscles can help maintain flexibility and reduce tension in the plantar fascia.
Monitoring the foot for any new lumps or changes allows for early intervention if a fibroma begins to return. Maintaining overall foot health and regular communication with a healthcare provider can help manage the condition long-term.