Plantar Fibroma: Symptoms, Types, Causes and Treatment

Plantar fibroma is a benign but often persistent condition that affects the arch of the foot. Though non-cancerous, it can significantly impact daily life, especially when pain or functional limitations arise. This article explores the key symptoms, types, causes, and treatment options for plantar fibroma, providing a comprehensive, research-backed guide for patients and clinicians alike.

Symptoms of Plantar Fibroma

Plantar fibroma typically presents as one or more lumps or nodules on the sole of the foot. While many people discover these nodules by chance, for others, they can become painful and interfere with walking or standing. Understanding these symptoms is crucial for timely diagnosis and management.

Symptom	Description	Frequency/Context	Sources
Lump/Nodule	Firm, subcutaneous mass on sole	Most common, often medial/central arch	1 6 7 9
Pain	Discomfort, especially with pressure	With growth or nerve involvement	1 7 9 4
Tenderness	Sensitive to touch or pressure	Variable; not always present	1 6 9
Functional Impact	Difficulty with ambulation, footwear	Severe or advanced cases	7 8 15

Table 1: Key Symptoms

Common Presenting Features

The hallmark of plantar fibroma is a noticeable lump in the arch of the foot, most often along the medial or central bands of the plantar fascia. These nodules are usually firm, deeply set, and fixed in place. While some remain painless for years, others become tender, especially if they enlarge or press against nerves and blood vessels 1 6 9.

Pain and Activity Limitation

Pain isn't always present in early cases, but as the fibroma grows, it can cause discomfort—particularly when walking, standing for long periods, or wearing shoes that press on the mass 7 8 15. Some patients report increasing difficulty with daily activities, especially if the nodule is located in a weight-bearing area.

Other Associated Symptoms

• Tenderness: Sometimes present, especially if the lesion is inflamed or subjected to pressure 1 6.
• Functional Impact: In advanced or multiple cases, there can be significant impact on gait, leading to adaptations that may cause secondary problems like calluses or postural issues 7 15.

Types of Plantar Fibroma

Plantar fibroma is not a one-size-fits-all diagnosis. There are variations in depth, extent, and involvement of surrounding tissues, which influence both symptoms and treatment approaches.

Type	Description	Distinguishing Features	Sources
Superficial	Grows within plantar fascia	Confined to fascia, less invasive	4 2 6
Deep	Extends beyond fascia into soft tissue	Involves tendon, joint capsule, nerves	4 2
Single Nodule	Isolated mass	Most common	1 9 12
Multiple Nodules	More than one nodule, often bilateral	Higher recurrence risk	13 12 7

Table 2: Types of Plantar Fibroma

Superficial vs. Deep Types

• Superficial Type: This form is limited to the plantar fascia, growing just beneath the skin and often presenting as a firm, well-defined lump. It tends to be less aggressive and easier to treat surgically 4 2.
• Deep Type: This rarer variant breaks through the fascia, infiltrating surrounding structures such as tendons, joint capsules, or even neurovascular bundles. Deep types are more likely to cause pain, numbness, and functional limitations, and may complicate both surgical removal and recovery 4.

Single vs. Multiple Nodules

• Single Nodule: The majority of cases involve a solitary lump, typically slow-growing and asymptomatic in early stages 1 9.
• Multiple Nodules: Some individuals develop several nodules, sometimes on both feet. This pattern is associated with a higher chance of recurrence after treatment and may have a genetic predisposition 13 12.

Other Classification Considerations

• Staging Systems: Some researchers have proposed staging systems based on the extent of fascia involvement, skin adherence, and depth. Higher stages correlate with increased surgical complexity and risk of wound healing problems 12.
• Associated Conditions: A subset of patients also have similar fibromatosis in the hands (Dupuytren's contracture) or have a family history of the disease, suggesting a systemic or genetic component 5 12.

Causes of Plantar Fibroma

The exact cause of plantar fibroma remains elusive. However, research has identified several risk factors and possible contributing mechanisms that may help explain who is most at risk and why the condition develops.

Cause/Risk Factor	Description	Strength of Evidence	Sources
Genetic Predisposition	Family history of fibromatosis	Moderate	5 12 13
Trauma/Microtrauma	Repetitive injury to plantar fascia	Possible trigger	7 6 8
Age & Sex	More common in middle-aged adults, males	Observational	6 12
Associated Diseases	Dupuytren’s, Peyronie’s, epilepsy, diabetes	Observational	5 6 12
Unknown	No clear cause identified	Most cases	7 6 8

Table 3: Causes and Risk Factors

Genetic and Familial Factors

There is evidence that plantar fibroma has a hereditary component. Individuals with relatives affected by palmar (Dupuytren’s contracture) or plantar fibromatosis are at increased risk. Some families show involvement of both hands and feet, suggesting a genetic predisposition 5 12 13.

Trauma and Repetitive Stress

Though not universally present, repeated trauma or micro-injury to the plantar fascia is considered a potential trigger. Activities or occupations that place chronic stress on the soles may contribute to fibroma formation 7 8. However, most patients do not recall a specific injury.

Demographic and Systemic Associations

• Age and Sex: The majority of cases occur in middle-aged adults, with a slight male predominance 6 12.
• Associated Conditions: Plantar fibromatosis is sometimes linked with other fibrous tissue disorders, such as Dupuytren’s contracture (hands), Peyronie’s disease (penis), epilepsy, diabetes, and even alcohol abuse 5 6 12.
• Unknown Etiology: Despite these associations, many cases arise without a clear cause, and the pathophysiology remains poorly understood 7 6 8.

Treatment of Plantar Fibroma

Treatment for plantar fibroma ranges from simple observation to advanced surgical interventions. The choice depends on symptom severity, nodule size, and patient preference. As recurrence can be a significant problem, careful consideration of risks and benefits is essential.

Treatment Type	Description	Effectiveness/Considerations	Sources
Observation	Watchful waiting for small, asymptomatic nodules	Suitable for mild cases	6 7 8
Conservative Therapy	Steroid injections, verapamil, radiation, ESWT	Variable success, non-invasive	3 7 8 15
Surgery	Excision, partial/total fasciectomy	Risk of recurrence, complications	1 7 11 12 13 14
Adjunctive Therapy	Post-op radiotherapy, pharmacologics	May reduce recurrence	11 7 3

Table 4: Treatment Options

Observation and Conservative Management

• Observation: For nodules that are small and not causing pain or functional impairment, a watch-and-wait approach is often recommended. Many nodules remain stable for years 6 8.
• Conservative Therapies: When symptoms develop, various non-surgical options are available:
  • Steroid Injections: Can provide temporary reduction in pain and size 7 8.
  • Topical/Oral Medications: Agents like verapamil and tamoxifen have been tried with mixed results 7 8.
  • Radiation Therapy: Sometimes used in early or recurrent cases to slow progression 7 8 3.
  • Extracorporeal Shockwave Therapy (ESWT): Has been shown in small studies to reduce pain and soften nodules, with minimal side effects 15.

Surgical Intervention

Surgery is reserved for cases where pain or functional impairment is significant and conservative measures have failed.

• Local Excision: Removal of only the nodule. This approach has a high recurrence rate—up to 100% in some studies 11 13 14.
• Wide Excision/Partial Fasciectomy: Removing the nodule plus a margin of healthy fascia. Slightly lower recurrence than local excision, but still significant 12 13 14.
• Total Plantar Fasciectomy: Complete removal of the plantar fascia. This approach has the lowest recurrence rate (as low as 25%), but carries the risk of complications such as wound healing problems and changes to foot mechanics 11 12 13.
• Adjunctive Radiotherapy: When combined with surgery, postoperative radiotherapy may further reduce recurrence risk, though more research is needed 11.

Risks and Complications

• Recurrence: A major challenge, especially with limited excision. The risk increases if multiple nodules are present or if there is a family history of fibromatosis 11 13.
• Wound Healing Issues: Higher-stage or more extensive surgeries increase the risk of delayed healing and may require skin grafting 12.
• Nerve Injury & Functional Change: Deep or extensive resections can involve nerves, leading to numbness or pain, and may alter foot biomechanics 4 12.

Emerging and Investigational Therapies

Newer therapies, such as collagenase injections or various pharmacologic agents, are being explored, but evidence for their efficacy in plantar fibromatosis is still limited 8.

Conclusion

Plantar fibroma is a benign but sometimes troublesome condition of the foot, characterized by fibrous nodules in the plantar fascia. Key points from this comprehensive review include:

• Symptoms: Most patients experience a firm lump in the foot arch, sometimes accompanied by pain or difficulty walking.
• Types: Plantar fibromas vary in depth, number, and extent; superficial and deep types, as well as single or multiple nodules, are recognized.
• Causes: While the exact cause is unknown, genetic predisposition, repetitive trauma, and association with other fibromatoses are implicated.
• Treatment: Options range from observation for mild cases to conservative therapies (steroids, ESWT, radiotherapy) and surgery for severe disease; recurrence is a significant challenge, especially after limited surgical excision.

In summary:

• Early diagnosis and individualized treatment planning are essential.
• Most cases can be managed conservatively, but surgery may be necessary for symptomatic relief.
• Risk of recurrence and complications should guide both patient counseling and therapeutic choice.
• Ongoing research may offer new, less invasive treatment options in the future.

By understanding the symptoms, classification, causes, and available treatments for plantar fibroma, patients and healthcare providers can work together to achieve the best possible outcomes.