Plantar fibramotosis is a tissue disorder where an excess of collagen or fibrous tissue forms into a firm, nodular mass that can be felt on the bottom of the foot under the skin. The most common location is at the arch of the foot over the plantar fascia, the soft tissue band that runs on the bottom of your foot from your heel to your toes. The mass can start small, but progressively and slowly increase in size to the point where standing or walking becomes painful.
A vast medical history is necessary when diagnosing a patient with a possible plantar fibroma. This condition tends to occur more frequently in patients with a history of seizures or epilepsy. Patients with excess alcohol intake are also prone to the condition. It is similar in clinical features as a Peyronie’s disease and Dupuytren’s disease, a condition that can occur to your hands or groin region.
HOW ARE PLANTAR FIBROMAS FORMED
There currently is no particular known causes of plantar fibromas. However, there has been a lot of research that suggest possible causes.
Trauma to the plantar fascia is thought to be a primary cause of the condition. Injury can cause thickening and tightening to the plantar fascia, leading to tears and inflammation. During the healing process, collagen forms in excess and causes the soft tissue mass to arise.
Most patients commonly find themselves genetically predisposed to the condition as a family member has had the condition.
There have been numerous studies and reports that suggest certain blood pressure medications (beta-blockers) have caused fibrotic tissue disorders. Supplementations such as chondroitin or vitamin C promote production of collagen, which has been linked to fibroma formation when in excess.
Plantar fibromas have frequently been linked to various medical conditions such as diabetes, seizure disorders and chronic liver disease. Long-term alcohol use has also been connected to the condition.
- Raised, firm soft tissue mass to the bottom of the foot
- Pain while walking or standing
- Feels like walking on a rock or pebble
Plantar fibromas are tricky to treat due to an unknown cause and very high recurrence rate. Though conservative and surgical options have shown great results, do not be alarmed if the mass returns as it is known for recurring frequently.
There are a variety of treatment options available to treat the condition non-invasively.
- Corticosteroid injections into the fibroma to decrease the size.
- Orthotics with padding to offload the area
- Fascia stretches to break up collagen buildup
One non-invasive treatment option that has show promising results is the application of a Transdermal Verapamil 15% Gel to the skin. Verapamil is a calcium channel blocker that orally is used to treat blood pressure. In its topical form, it has been shown to seep through the skin and “remodel” the tissue, allowing the collagen to reduce in size.. If used properly and the fibroma remodels, recurrence is unusual as the structure of the tissue itself has changed.
If conservative options fail, surgery would be recommended. A common procedure involves removing the fibroma along with the surrounding plantar fascia. The patient is often told before surgery that he/she will be given an orthotic to give support to the arch.