What Is a Plantar Fibroma?

A plantar fibroma is a benign fibrous nodule that develops within the plantar fascia — the thick band of connective tissue running along the bottom of the foot. Unlike plantar fasciitis (inflammation of the fascia), a plantar fibroma is a discrete growth that can be felt as a firm, rubbery lump in the arch of the foot.

When multiple nodules are present or when the condition is progressive, it may be referred to as plantar fibromatosis or Ledderhose disease — named after the German surgeon Georg Ledderhose who described it in 1894.

What Causes Plantar Fibromas?

The exact cause is not fully understood. Fibromas represent abnormal proliferation of fibroblasts (cells that produce connective tissue) within the plantar fascia. Contributing factors may include:

• Repeated micro-trauma to the plantar fascia
• Genetic predisposition (higher rates in people of Northern European descent)
• Association with Dupuytren’s contracture (similar fibromatosis of the hand)
• Liver disease, diabetes, and certain medications (beta-blockers, some anti-seizure drugs) have been implicated
• Alcoholism is associated in some studies

Plantar fibromas are more common in middle-aged and older adults and slightly more prevalent in men than women.

Symptoms

The primary symptom is a palpable nodule in the arch — typically in the middle third of the plantar fascia. Most nodules are 1–3 cm in size, though they can grow larger. Pain is variable: some fibromas are entirely painless, while others cause significant discomfort during standing, walking, or when direct pressure is applied (as from tight footwear).

Ledderhose disease may progress slowly over years, with new nodules forming and existing ones enlarging. In advanced cases, the nodules can affect toe extension and alter gait mechanics.

Diagnosis

Clinical examination is usually sufficient for diagnosis — a firm, non-mobile nodule in the plantar fascia arch is characteristic. Ultrasound can confirm the diagnosis and delineate the nodule’s size and depth. MRI is occasionally used to assess involvement of adjacent structures and to distinguish fibromas from other soft tissue masses, though malignant transformation is extremely rare.

Non-Surgical Treatment Options

Orthotics and Offloading

Custom orthotic insoles with a recessed area (cutout) beneath the fibroma reduce direct pressure and are effective for pain management in many patients. Accommodative padding achieves similar goals without the cost of custom devices.

Corticosteroid Injections

Intralesional corticosteroid injections can temporarily soften a fibroma and reduce pain, though they do not eliminate the nodule. Repeat injections carry risks of fat pad atrophy and fascia weakening.

Verapamil Injections

Some podiatric physicians use intralesional verapamil (a calcium channel blocker that inhibits fibroblast activity) to reduce nodule size. Evidence is promising but limited.

Radiotherapy

Low-dose radiation therapy is used in some centers for progressive Ledderhose disease, with studies showing meaningful reduction in nodule size and pain, particularly in early-stage disease.

Surgical Treatment

Surgery to excise a plantar fibroma is reserved for nodules causing significant pain that fails conservative treatment. Partial fasciectomy (removing the nodule and a margin of surrounding fascia) has a significant recurrence rate. Total plantar fasciectomy has lower recurrence but is a major procedure with a lengthy recovery and risk of complications including nerve injury, flattening of the arch, and hammertoe formation.

Surgery is therefore considered a last resort and is undertaken only after 6–12 months of failed conservative management.

Living with Plantar Fibromas

Many patients manage successfully with accommodative footwear and orthotics indefinitely. Monitoring for growth or new nodule formation is important, and periodic reassessment ensures treatment remains appropriate as the condition evolves.

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Dr. Tom Biernacki, DPM

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.