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

What Is Plantar Fibromatosis?

Plantar fibromatosis — also known as Ledderhose disease — is a benign but progressive condition involving the formation of firm nodules within the plantar fascia (the band of connective tissue along the arch of the foot). While not malignant, these nodules can cause significant discomfort, particularly when walking or wearing tight shoes, and may progressively enlarge or multiply over time.

At Balance Foot & Ankle in Howell and Bloomfield Township, Michigan, we diagnose and manage plantar fibromatosis at all stages, from asymptomatic nodules to extensive disease requiring surgical intervention.

Causes and Risk Factors

Plantar fibromatosis is part of a spectrum of fibromatosis conditions affecting connective tissue. It is related to Dupuytren’s contracture (hand), Peyronie’s disease (penile), and Garrod’s knuckle pads. A genetic predisposition exists — the condition runs in families and is more common in individuals of Northern European descent. Trauma (repeated micro-injury to the fascia), chronic plantar fascia stress, certain medications including beta-blockers and anti-epileptics, and systemic conditions including diabetes and liver disease are associated risk factors. The condition is more common in middle-aged adults and slightly more common in men.

Symptoms

The hallmark of plantar fibromatosis is one or more palpable, firm nodules along the plantar fascia, typically in the middle or inner arch rather than the heel. Unlike plantar fasciitis, which causes pain primarily at the heel, plantar fibromatosis pain is located in the arch, directly over the nodule(s). The nodules themselves are firmly adherent to the fascia and cannot be moved independently. Pain worsens with prolonged walking or standing and with direct pressure on the nodule from footwear. Unlike malignant soft tissue tumors, plantar fibromatosis nodules are typically slowly enlarging over months to years rather than rapidly growing over weeks.

Diagnosis

Clinical diagnosis is usually straightforward based on the characteristic location and firmness of the nodules. Ultrasound confirms the diagnosis and characterizes nodule size, echogenicity, and relationship to the plantar fascia. MRI provides additional detail including extent of fascial involvement and proximity to neurovascular structures — important for surgical planning. Biopsy is rarely needed and generally avoided unless the clinical picture is atypical and malignancy cannot be excluded clinically.

Conservative Treatment

Most plantar fibromatosis cases are initially managed conservatively. Custom orthotics with a plantar fibromatosis accommodation (an offloading cavity directly under the nodule) reduce direct pressure and provide significant pain relief for many patients. Physical therapy and stretching maintain plantar fascia flexibility and prevent adjacent fascial tightening. Cortisone injections into the nodule provide temporary symptomatic relief but do not reduce nodule size and are associated with plantar fascia weakening with repeated injections. Verapamil gel — a calcium channel blocker topical preparation — shows promising results for reducing nodule size in some studies. Low-level laser therapy and extracorporeal shockwave therapy have emerging evidence for symptom reduction.

Surgical Treatment

For plantar fibromatosis that is painful despite conservative care or causes significant functional limitation, surgical excision is an option. Because plantar fibromatosis infiltrates into the fascia (unlike a simple cyst that can be completely enucleated), achieving clear surgical margins requires removing a significant portion of the plantar fascia. Partial fasciectomy (removing the nodule and surrounding affected fascia) carries lower recurrence risk than simple nodule removal but requires more extensive surgery and longer recovery. Total plantar fasciectomy is reserved for extensive disease. Recurrence after surgery occurs in 25-50% of cases, and some patients develop postoperative flatfoot deformity from fascia removal — factors that must be carefully weighed when surgical intervention is considered.

Foot or Ankle Pain? We Can Help.

Balance Foot & Ankle — Howell & Bloomfield Township, MI

📅 Book Online
📞 (810) 206-1402

Lumps in Your Foot Arch? It Could Be Plantar Fibromatosis

Plantar fibromatosis (Ledderhose disease) causes firm nodules in the arch that can become painful and limit walking. Dr. Tom Biernacki offers conservative management and advanced treatment options for this challenging condition.

Learn About Plantar Fibromatosis Treatment | Book Your Appointment | Call (810) 206-1402

Clinical References

1. Espert M, et al. Ledderhose disease: plantar fibromatosis. European Journal of Radiology. 2019;116:140-152.
2. Young JR, et al. Plantar fibromatosis. Radiographics. 2019;39(5):1462-1478.
3. Sammarco GJ, Mangone PG. Classification and treatment of plantar fibromatosis. Foot and Ankle International. 2000;21(7):563-569.

Your Board-Certified Podiatrists

Dr. Tom Biernacki, DPM

Board-Certified · FACFAS

Dr. Carl Jay, DPM

Board-Certified Podiatrist

Dr. Daria Gutkin, DPM

Podiatrist

Dr. Tom Biernacki, DPM

Affiliate Disclosure: This page contains affiliate links to products we recommend. If you purchase through these links, Balance Foot & Ankle may earn a small commission at no additional cost to you. We only recommend products we use with our patients.

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.