Plantar Fibromatosis (Ledderhose Disease)

Plantar fibromatosis (Ledderhose disease) is a rare condition that affects your plantar fascia, the thick layer of connective tissue that protects and supports the bottom of your foot. In plantar fibromatosis (pronounced “PLANT-ter fi-broh-muh-TOH-sis”), small, hard nodules (growths) called plantar fibromas develop on the arch of your foot. They may feel like peas stuck on the inside of your shoe. These nodules grow rapidly (aggressively) to be about 1 to 2 centimeters in size.

While these growths are noncancerous (benign), they can become quite painful. They can affect your ability to stand or walk and may decrease your quality of life. If you develop any symptoms of Ledderhose disease, reach out to your healthcare provider. They can examine your foot and provide treatment options so you can find relief.

What are the stages of plantar fibromatosis?

There are three stages to plantar fibromatosis:

1. Proliferative phase. There’s an increase in the number of fibroblasts (cells that create connective tissue) in the area and very little collagen.
2. Active phase. Fibroblasts continue to grow, and there’s more collagen. Nodules begin to form.
3. Residual phase. Fibroblast activity decreases, and collagen growth is rapid. Scar tissue forms and squeezes together (contracts).

Symptoms of plantar fibromatosis

Ledderhose disease causes a collection of bumps to form on the bottom of your foot. It can be uncomfortable and make it hard for you to perform your daily activities. Other plantar fibromatosis symptoms may include:

• Foot pain and swelling
• Difficulty standing and/or walking
• Toes curling down toward the bottom of your foot
• Inability to straighten your toes

Ledderhose disease causes

Researchers don’t know what exactly causes plantar fibromatosis. It may be related to several factors, including:

• Genetics
• Related health conditions, like Dupuytren contracture, Peyronie’s disease and knuckle pads
• Trauma or injury to your feet

Risk factors of plantar fibromatosis

Ledderhose disease affects people of any age. But, it’s more common in people between the ages of 30 and 50. It’s also more common in people:

• Of northwestern European descent
• Who are male
• Who smoke

In addition, plantar fibromatosis often affects people who have certain health conditions, including:

• Alcohol use disorder
• Diabetes
• Dupuytren contracture
• Epilepsy
• Frozen shoulder
• Knuckle pads
• Peyronie’s disease

How doctors diagnose Ledderhose disease

Before examining your foot, your healthcare provider may ask several questions, including:

• Do you have a biological family history of plantar fibromatosis?
• Have you ever been diagnosed with a similar condition, like Dupuytren contracture?
• Do you have diabetes?
• Do you have epilepsy?

Your healthcare provider will then examine your foot. They’ll:

• Check for swelling, bruising, lumps, sores or deformities
• Note any tender or painful areas along the bottom of your foot and heel
• Look over your Achilles tendon and the muscles around the tendon
• Check your foot’s range of motion
• Ask you to walk a short distance and note how your feet and ankles move

Tests that are used to diagnose plantar fibromatosis

Your healthcare provider may conduct the following tests to diagnose plantar fibromatosis:

• Ultrasound. After examining your signs, symptoms and medical history, your healthcare provider may perform an ultrasound to confirm their clinical diagnosis.
• Magnetic resonance imaging (MRI). With advanced stages of Ledderhose disease, nodules may extend deeper into the bottom of your foot (although, this is extremely rare). An MRI shows how aggressive your case may be.
• Biopsy. Your healthcare provider may remove some tissue, cells or fluid from your foot (biopsy). A biopsy will confirm that a growth isn’t a cancerous tumor.

How is plantar fibromatosis treated?

In its earliest stages, plantar fibromatosis treatment may include:

• Ice. Apply an ice pack covered in a light towel to the bottom of your foot for up to 20 minutes, three to four times per day.
• Medications. Over-the-counter nonsteroidal anti-inflammatory medications (NSAIDs) — like aspirin, ibuprofen and naproxen — can reduce pain and inflammation.
• Orthotics. Over-the-counter (OTC) shoe inserts or custom orthotics provide relief. You can cut holes into your shoe inserts around the growths on your foot to prevent direct pressure.
• Massage. Gently massage the bottom of your foot. Avoid touching the growths because that may increase your pain.
• Physical therapy. Work with a physical therapist to stretch and strengthen the connective tissues in the bottom of your feet.

If your pain doesn’t decrease or stop after several months of conservative treatment, your healthcare provider may suggest:

• Intralesional steroids
• Verapamil
• Radiation therapy
• Extracorporeal shock wave therapy (ESWT)
• Tamoxifen
• Sorafenib
• Collagenase injection
• Surgery

When should I see my healthcare provider?

Schedule an appointment with your healthcare provider if you:

• Notice growths or bumps near the middle of the bottom of your feet
• Have difficulty standing or walking
• Experience long-lasting pain in the bottom of your feet
• Have trouble straightening your toes

Questions you may wish to ask your provider include:

• What activities should I avoid? For how long?
• What can I do to manage my pain?
• What treatments do you recommend?

What can I expect if I have plantar fibromatosis?

Ledderhose disease can cause painful growths on the bottom of your feet that may continue to get worse without treatment. Fortunately, the disease doesn’t spread and isn’t life-threatening. But you should still see your provider to rule out any other conditions and seek appropriate treatment.