A plantar fibroma is a noncancerous growth that forms as a fibrous knot or nodule within the plantar fascia. This tissue band stretches from the heel to the toes along the bottom of the foot, forming the arch. While plantar fibromas are generally benign, they typically do not reduce in size or disappear without treatment. These growths can develop in one or both feet and may appear as a single lump or multiple nodules.
Non-Surgical Treatments
Conservative approaches are typically the initial course of action for managing plantar fibromas, primarily focusing on pain relief rather than complete removal of the growth. Non-surgical options aim to reduce pressure and discomfort caused by the fibroma. These methods include stretching exercises, orthotic devices, physical therapy, corticosteroid injections, and pain management strategies.
Stretching exercises for the foot, ankle, and calf muscles can alleviate tension on the plantar fascia. Specific stretches include calf stretches, performed by leaning into a wall with one foot back, and arch stretches, done by pulling the toes toward the shin. These exercises, often held for 20-30 seconds and repeated multiple times, can improve flexibility and reduce scar tissue, although they may not directly shrink the fibroma.
Orthotic devices, such as shoe inserts, are commonly used to reduce pressure on the fibroma and redistribute weight away from the affected area. Custom orthotics are often preferred as they can be tailored to conform closely to the foot’s arch, providing targeted support and making walking more comfortable. Some orthotics may feature specific cutouts to accommodate the fibroma and prevent direct pressure.
Physical therapy can involve various techniques, including massage to break up tissue accumulation and improve circulation. Some physical therapy methods can deliver anti-inflammatory medication into the fibroma without injections. Shockwave therapy is also used to break up scar tissue and stimulate the regeneration of new, flexible tissue in the nodule, though its effectiveness in reducing nodule size is still being studied.
Corticosteroid injections involve injecting anti-inflammatory medication directly into the fibroma. This can help shrink the growth and relieve pain, particularly when walking. While injections can offer temporary relief, the fibroma may eventually return to its original size. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen also reduce pain and inflammation. Topical gels, such as Verapamil cream, can be applied to manage inflammation and potentially shrink the fibroma over time.
Surgical Considerations
Surgery becomes a consideration when non-surgical treatments have not provided sufficient relief from pain or discomfort, or if the fibroma continues to grow in size, interfering with daily activities like walking or wearing shoes. The decision to proceed with surgery is typically made after conservative measures have been exhausted over several months.
A common surgical procedure is a fasciectomy, which involves removing the fibrous tissue. Approaches include local excision, where only the fibroma is removed, or wide excision, which removes the fibroma with a small margin of surrounding tissue. In some cases, a partial plantar fasciectomy, removing a portion of the plantar fascia, or even a complete plantar fasciectomy may be performed, though the latter is rare.
The procedure is usually performed under local or general anesthesia. The surgeon removes the fibroma from the plantar fascia, and the wound is closed with sutures. Risks include infection, swelling, numbness, and uncomfortable scarring. Recurrence is also a risk, with local excisions having a higher rate than complete fasciectomy. Surgical removal may also lead to a flattening of the arch or hammertoes.
Post-Treatment Care
Following treatment, whether non-surgical or surgical, a structured post-treatment plan is important for recovery and long-term management. Rehabilitation typically involves rest, elevation, and a gradual return to activity to promote healing and minimize complications. For surgical patients, the initial phase often involves keeping the foot non-weight-bearing in a cast, boot, or bandage for about 1-2 weeks to allow the incision to heal.
After this initial period, stitches are usually removed, and gentle calf stretching exercises may begin. Patients may gradually start weight-bearing with supportive footwear, such as a soft-soled shoe or a protective boot. Full recovery can vary significantly, ranging from 6 weeks to 6 months, depending on the extent of the procedure and individual healing capabilities. Most patients can resume light activities within 4-8 weeks, but a full return to sports or physically demanding work may take several months.
Physical therapy plays a significant role in regaining strength and flexibility, and addressing any scar tissue that may form. Regular follow-up appointments with a healthcare provider are advised to monitor progress, manage any residual pain or swelling, and detect potential recurrence. Adherence to medical advice, including wearing prescribed orthotics for continued foot support, is important for optimizing long-term outcomes and reducing the likelihood of the fibroma returning.