Plantar Fibromatosis Ledderhose Disease 2026 | DPM

Condition	Location	Palpation	Bilateral?	Associated Conditions	Treatment
Plantar Fibromatosis (Ledderhose)	Central or medial plantar fascia; mid-arch	Firm, nodular; attached to plantar fascia; non-mobile	25-50% bilateral	Dupuytren contracture; Peyronie disease; knuckle pads; epilepsy treatment	Conservative first; Xiaflex injection; radiation; surgery for refractory
Plantar Fibroma (Solitary)	Same location; single nodule	Single firm nodule; may be smaller	Usually unilateral	Same fibromatosis spectrum	Orthotic offloading; cortisone; excision
Plantar Fasciitis	Medial calcaneal tubercle; proximal fascia	Diffuse tenderness at heel; no nodule	Bilateral 30%	Obesity; flat feet; high arch; occupational standing	Stretching; orthotics; cortisone; ESWT; PRP
Ganglion Cyst (Plantar)	Variable plantar location	Soft; fluctuant; transilluminates	Unilateral typically	Tendon sheath; joint capsule origin	Aspiration; surgical excision
Epidermoid Inclusion Cyst	Plantar skin; subcutaneous	Mobile; soft-firm; not attached to fascia	Unilateral	Prior trauma; puncture wound history	Surgical excision

Treatment	Indication	Protocol	Success Rate	Notes
Custom Orthotic (offloading cut-out)	All patients; first-line symptom management	Plantar fibroma cut-out in orthotic; reduces direct nodule pressure	60-70% pain relief; does not reduce nodule size	Mainstay for asymptomatic or mildly symptomatic fibromas
Corticosteroid Injection	Symptomatic nodule; first-line active treatment	Ultrasound-guided triamcinolone into fibroma; 1-3 injections	50-60% pain reduction; 20-30% nodule softening; rarely eliminates	May temporarily soften nodule; atrophy risk to fat pad
Collagenase Injection (Xiaflex)	Symptomatic plantar fibromatosis; off-label (FDA-approved for Dupuytren)	Collagenase clostridium histolyticum injection into fibroma	Emerging; 60-80% nodule softening in small series; best evidence is off-label	Most promising non-surgical option; limited by off-label status and cost
Radiation Therapy (low-dose)	Early-stage fibromatosis; multiple or recurrent nodules	21-30 Gy in fractions; used in Europe more widely	70-80% disease stabilization; prevents progression	Best for preventing growth; not for pain relief alone; long-term safety profile good
Surgical Excision	Refractory to all conservative; functionally limiting	Wide local excision with fascia margins; partial or total fasciectomy	High recurrence: 25-60% after local excision; 10-20% after total fasciectomy	High recurrence rate; surgery reserved for severe cases; total fasciectomy if Ledderhose pattern

https://www.youtube.com/watch?v=8opvH3qxkW4

What Is Plantar Fibromatosis?

Plantar fibromatosis — known medically as Ledderhose disease — is a benign fibro-proliferative disorder of the plantar fascia characterized by the formation of firm, rubbery nodules within the plantar fascia along the arch of the foot. Unlike plantar fasciitis, which involves microtearing and inflammation of the fascia, plantar fibromatosis involves an abnormal proliferation of fibroblasts and collagen deposition within the fascia itself.

At Balance Foot & Ankle PLLC, Dr. Tom Biernacki evaluates plantar fibromatosis carefully because the condition behaves unpredictably — some nodules remain stable and minimally symptomatic for years, while others grow progressively, become painful, and eventually impair the ability to walk or stand comfortably.

Causes and Associated Conditions

The exact cause of plantar fibromatosis is not fully understood, but several associations are well-established. It occurs more frequently in individuals of Northern European descent and in men more than women. Contributing factors and associated conditions include:

Genetics: A family history of plantar fibromatosis or related fibromatoses (Dupuytren’s contracture in the hand, Peyronie’s disease) suggests a genetic predisposition. Patients with Dupuytren’s contracture have a significantly elevated risk of plantar fibromatosis.

Repetitive microtrauma: Repeated mechanical stress on the plantar fascia may trigger abnormal fibroblast proliferation in susceptible individuals.

Medications: Long-term use of certain anticonvulsants (particularly phenobarbital) has been linked to fibromatosis.

Systemic conditions: Diabetes, liver disease, and thyroid disorders are associated with increased fibromatosis risk.

Symptoms

The primary finding is one or more firm, palpable nodules along the medial arch of the plantar fascia, most commonly in the central non-weight-bearing zone. Nodules are typically non-tender initially but may become progressively painful as they enlarge or are compressed by walking or shoe pressure. In advanced cases, multiple nodules may cause a functional plantar spur that makes weight-bearing on the arch extremely uncomfortable.

Importantly, plantar fibromatosis nodules are distinct from plantar fascia tears, ganglion cysts, and malignant soft tissue tumors — accurate diagnosis is critical.

Diagnosis

Dr. Biernacki diagnoses plantar fibromatosis through clinical examination combined with diagnostic ultrasound, which clearly demonstrates the characteristic hypoechoic nodule within the plantar fascia. MRI provides additional detail about nodule size, depth, and relationship to adjacent structures — important for surgical planning. The diagnosis can typically be confirmed without biopsy, though atypical presentations warrant histological confirmation to exclude soft tissue sarcoma.

Conservative Treatment

Custom orthotics with plantar accommodation: A custom orthotic with a cut-out or deflective accommodation beneath the nodule offloads direct pressure during walking, significantly reducing nodule-related pain. This is the cornerstone of conservative management and allows most patients to remain active comfortably.

Padding and footwear modification: Soft, accommodative arch pads and wide-toe-box footwear with cushioned insoles reduce direct nodule compression. Avoiding barefoot walking on hard surfaces is essential.

Corticosteroid injections: Carefully placed injections into the nodule can reduce local inflammation and temporarily decrease nodule firmness. Long-term reduction in nodule size is variable.

Collagenase injections (Xiaflex): Used with success in Dupuytren’s contracture, collagenase injections are increasingly explored for plantar fibromatosis as an off-label treatment. Early results in selected cases are promising for reducing nodule size.

Surgical Treatment

When nodules are large, numerous, severely painful, or significantly limit function despite conservative care, surgical excision is indicated. The key surgical principle for plantar fibromatosis is wide local excision — removing not just the nodule but the involved plantar fascia tissue around it to reduce the risk of recurrence, which is higher with simple nodule excision.

The surgical site heals over 6–10 weeks. Recurrence rates after wide excision range from 25–60% depending on disease extent and patient factors — patients should be counseled about this possibility before surgery.

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