What Is Plantar Fibromatosis?

Plantar fibromatosis, also known as Ledderhose disease, is a benign but potentially troublesome condition characterized by the formation of firm, fibrous nodules within the plantar fascia — the thick connective tissue band running along the sole of the foot. These nodules grow slowly and are attached to the fascia, making them immovable when you try to push them side to side, unlike a simple cyst. They can be found anywhere along the plantar fascia but most commonly develop in its central and medial aspects.

Unlike plantar fasciitis, which involves inflammation at the heel insertion, plantar fibromatosis produces palpable growths in the arch of the foot. Single or multiple nodules may develop, and the condition is bilateral in roughly 25% of cases. While many patients have no pain from their nodules, others develop significant discomfort with walking as the lesion grows large enough to bear weight or compress surrounding structures. At Balance Foot & Ankle in Howell and Bloomfield Township, Michigan, Dr. Tom Biernacki DPM and Dr. Carl Jay DPM provide expert evaluation and management of this condition.

Who Gets Plantar Fibromatosis?

Plantar fibromatosis is associated with a hereditary predisposition toward abnormal fibroblast proliferation. It belongs to a family of fibromatoses that includes Dupuytren’s contracture (palmar fibromatosis affecting the hand) and Peyronie’s disease. The conditions frequently coexist — up to 65% of patients with plantar fibromatosis have Dupuytren’s contracture, and this combination suggests a systemic diathesis toward fibroblast hyperactivity.

Risk factors include male gender, Northern European ancestry, a positive family history, chronic liver disease, epilepsy (particularly with phenytoin use), diabetes, and alcohol use. The condition most commonly presents in middle-aged adults, though it can occur at any age. Interestingly, there may be an association with repetitive microtrauma to the plantar fascia, and the condition is sometimes seen in athletes with a history of repetitive foot loading.

Symptoms and Clinical Presentation

The typical presentation is a firm, non-tender (or mildly tender) nodule in the arch of the foot discovered incidentally or noticed as a new growth. Many patients first become aware of their nodule when they feel it while putting on socks. As nodules enlarge, direct pressure from the ground during standing or walking can produce localized discomfort. Very large nodules may cause difficulty wearing standard footwear.

The nodules are firmly adherent to the plantar fascia and feel rubbery to hard in consistency — quite different from the soft, compressible feel of a lipoma or ganglion cyst. They do not transilluminate (light does not pass through them), which helps distinguish them from cystic lesions in clinical examination. Pain, when present, is typically worse barefoot and on hard surfaces, and may radiate into the toes or up into the arch.

Diagnosis: Confirming the Diagnosis and Ruling Out Malignancy

While the clinical diagnosis is usually straightforward, imaging helps confirm the diagnosis and provides information relevant to treatment planning. Ultrasound typically shows a well-defined, hypoechoic (dark) nodule within the plantar fascia, often with internal vascularity on Doppler imaging. MRI provides superior soft-tissue detail and is useful for larger, more complex lesions or when the diagnosis is uncertain.

Biopsy is rarely necessary for typical presentations but may be warranted for lesions with atypical imaging features, unusually rapid growth, or clinical characteristics suggesting a more aggressive process. On histology, plantar fibromatosis shows spindle-shaped fibroblasts within a collagenous stroma — a benign, though locally proliferative, process.

Conservative Treatment Approaches

Small, asymptomatic nodules require no treatment beyond monitoring and reassurance. For symptomatic lesions, the initial approach focuses on offloading the nodule to reduce direct pressure during walking. A custom orthotic with a cutout or recessed area beneath the nodule effectively redistributes plantar pressure away from the lesion. Cushioned insoles with similar modifications are a simpler alternative for milder cases.

Corticosteroid injection into and around the nodule can reduce inflammation and temporarily soften the tissue, providing pain relief in some patients, though it does not cause permanent nodule regression and carries a small risk of plantar fascia weakening. Intralesional collagenase injections, used successfully in Dupuytren’s contracture, are being investigated for plantar fibromatosis with promising early results.

Radiation therapy using low-dose superficial radiation (radiotherapy) has demonstrated effectiveness in European centers for slowing the growth and reducing the symptoms of plantar fibromatosis, particularly for lesions that are growing or causing significant discomfort. This approach is gaining acceptance and may be considered before surgery for larger, symptomatic lesions.

Surgical Treatment

Surgery is reserved for nodules that are large, significantly painful, unresponsive to conservative measures, and impacting quality of life. The standard surgical procedure is partial fasciectomy — excision of the nodule and surrounding plantar fascia. Total fasciectomy (removal of the entire plantar fascia) is sometimes advocated for more diffuse disease but carries higher complication risks.

The major challenge with surgical treatment of plantar fibromatosis is a high recurrence rate — estimated at 25–100% depending on the series and extent of resection. Local recurrences often grow more aggressively than the original lesion. For this reason, many specialists advocate exhausting conservative options, including radiotherapy, before proceeding to surgery. When surgery is performed, post-operative radiotherapy to the wound site may reduce recurrence risk.

Foot or Ankle Pain? We Can Help.

Balance Foot & Ankle — Howell & Bloomfield Township, MI

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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.