Introduction
Demographics
Causes
Clinical features
Complications
Diagnosis
Differential diagnosis
Treatment
Prevention
Outcome
Plantar fibromatosis, also known as Ledderhose disease, is a rare, benign hyperproliferative disorder characterised by slow-growing fibrous nodules within the plantar fascia (aponeurosis) of the foot.
Plantar fibromatosis is considered rare, though some studies suggest a greater incidence than previously thought. The condition is typically seen in middle-aged and older adults, although individuals of all ages can be affected. The condition shows a male predominance, with some reporting a 2:1 male-to-female ratio.
Plantar fibromatosis is often associated with other forms of superficial fibromatosis, such as Dupuytren contracture, Peyronie disease, or knuckle pads. Concomitant plantar fibromatosis has been reported in up to 25% of middle-aged or elderly patients with Dupuytren contracture.
Other risk factors include:
The exact cause of plantar fibromatosis is unknown, but both genetic and environmental factors (eg, chronic mechanical stress) are believed to contribute to its development. Although autosomal dominant inheritance has been demonstrated in Dupuytren disease, familial cases of Ledderhose disease are rare.
As a form of fibromatosis, Ledderhose disease involves the abnormal proliferation of fibroblasts, which deposit excess Type III collagen in the plantar fascia to form nodules.
In individuals with darker Fitzpatrick skin phototypes, the nodules may be less visually prominent but still detectable on palpation. The disease manifestations are otherwise consistent across different skin types.
Plantar fibromatosis is primarily diagnosed clinically, based on the presence of characteristic fibrous nodules within the plantar fascia.
Imaging studies, such as ultrasound or magnetic resonance imaging (MRI), can be used to assess the extent of the disease and differentiate it from other plantar masses.
Biopsy is often unnecessary but may be performed if the diagnosis is unclear or malignancy is suspected. Histopathological examination of excised tissue reveals dense fibrocellular tissue with parallel and nodular arrays of fibrocytes and collagen. See palmar fibromatosis and plantar fibromatosis pathology for more information.
The goals of treatment are to ameliorate pain, nodule size, and mobility. The condition can be managed conservatively in the initial stages, when lesions are small and/or minimally painful, with surgical excision reserved for persistent or advanced disease.
Plantar fibromatosis is surgically treated by removing part or all of the plantar fascia (plantar fasciectomy):
There are no established prevention strategies for plantar fibromatosis due to its uncertain aetiology. Early detection and management of related conditions, such as Dupuytren contracture, may help identify at-risk individuals.
Plantar fibromatosis is benign and has not been associated with malignant transformation. It carries a variable prognosis. Symptoms during early-stage disease can be managed with conservative treatment. However, the recurrence rate after surgery is significant, particularly with local excisions, necessitating ongoing monitoring and potential further treatment.
