Plantar Fibromatosis (Ledderhose Disease): Diagnosis, Injection, and Surgical Management

Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Plantar fibromatosis — Ledderhose disease — is a benign fibroproliferative condition of the plantar fascia producing firm, non-tender or mildly tender nodules within the central band of the plantar fascia. Although benign, plantar fibromatosis can be locally invasive, recurs after incomplete excision, and in advanced cases produces nodules large enough to impair weight-bearing. The condition is related to Dupuytren’s contracture of the hand and Peyronie’s disease, sharing the same fibroblastic proliferation pathology.

Clinical Presentation and Diagnosis

Plantar fibromatosis presents as one or more firm, palpable, non-tender or mildly tender nodules within the medial band of the plantar fascia — typically at the mid-plantar foot between the heel and the ball of the foot. The nodules are fixed to the plantar fascia and do not move with toe dorsiflexion (distinguishing them from plantar warts, which are epidermal and move with the skin). MRI characterizes the lesion extent and confirms the diagnosis: the nodules appear as low-to-intermediate signal on T1 and T2 sequences (reflecting dense fibrous tissue) — this MRI pattern distinguishes plantar fibromatosis from malignant soft tissue tumors, which typically show high T2 signal.

Treatment

Conservative management: accommodative insoles with cut-outs beneath the nodule reduce direct weight-bearing pressure — the most appropriate initial management for asymptomatic or mildly symptomatic cases. Intralesional steroid injection: reduces nodule size in 60–70% of patients in short-term follow-up; effects may be temporary. Collagenase injection (Xiaflex): evidence from small series shows nodule reduction with intralesional collagenase — may be more durable than corticosteroid. Radiation therapy (low-dose): reduces nodule progression in early-stage disease. Surgical excision: reserved for large nodules causing functional limitation and failing conservative management; wide excision including the entire plantar fascia medial band reduces but does not eliminate recurrence risk (recurrence 25–50% after local excision alone). Dr. Biernacki at Balance Foot & Ankle evaluates plantar nodules with diagnostic ultrasound and MRI when needed, and provides conservative management and surgical consultation for plantar fibromatosis. Call (810) 206-1402 at our Bloomfield Hills or Howell office.

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In-Office Treatment at Balance Foot & Ankle

If home care isn’t resolving your your foot or ankle concern, a visit with a board-certified podiatrist is the fastest path to accurate diagnosis and a personalized plan. At Balance Foot & Ankle Specialists, Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin offer same-day and next-day appointments at both our Howell and Bloomfield Hills offices. We perform on-site diagnostic ultrasound, digital X-ray, conservative care, advanced regenerative treatments, and minimally invasive surgery when indicated.

Call (810) 206-1402 or request an appointment online. Most insurance plans accepted, including Medicare, Blue Cross Blue Shield, Aetna, Cigna, and United Healthcare.

Frequently Asked Questions

When should I see a podiatrist?

See a podiatrist for any foot or ankle pain that persists more than 2 weeks, doesn’t improve with rest, limits your daily activities, or is accompanied by swelling, numbness, or skin changes. People with diabetes or circulation problems should see a podiatrist regularly even without symptoms.

What does a podiatrist treat?

Podiatrists diagnose and treat all conditions of the foot, ankle, and lower leg including plantar fasciitis, bunions, hammertoes, toenail problems, heel pain, nerve pain, diabetic foot care, sports injuries, fractures, and foot deformities — both surgically and non-surgically.

What can I expect at my first podiatry visit?

Your first visit includes a full medical history, physical examination of your feet and gait, and in-office diagnostic imaging if needed (X-rays, ultrasound). We’ll discuss your diagnosis and create a plan tailored to your foot type. Most visits take 30–45 minutes.

Need Treatment at Balance Foot & Ankle?

Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients at our Howell and Bloomfield Hills offices.

Book Online or call (810) 206-1402

Most Common Mistake We See

The most common mistake we see is: Waiting too long before seeking care. Fix: any foot pain lasting more than 4 weeks, or any sudden severe symptom, deserves a professional evaluation rather than more rest.

Warning Signs That Need Same-Day Care