Plantar fibromatosis — known eponymously as Ledderhose disease — is a benign proliferative fibroblastic condition causing firm nodule formation within the plantar fascia. While histologically benign, plantar fibromatosis is locally aggressive and associated with high recurrence rates after surgical excision, making nonsurgical management the preferred first-line approach for most patients.

Pathophysiology and Associated Conditions

Plantar fibromatosis involves myofibroblast proliferation and collagen overproduction within the plantar fascia, producing firm, adherent nodules of varying size. The condition affects both feet in 20–50% of patients. Associated conditions include Dupuytren’s contracture (palmar fibromatosis), Peyronie’s disease, and knuckle pad fibromatosis — collectively termed “fibromatosis diathesis” and more prevalent in patients with northern European ancestry, diabetes, chronic alcohol use, and certain anticonvulsant medications.

Clinical Presentation

Patients present with one or more firm, non-tender or mildly tender nodules in the non-weight-bearing medial arch. Nodules are characteristically fixed to the plantar fascia and do not transilluminate (distinguishing them from cysts). Nodules may enlarge over months to years, with larger nodules producing pressure-related discomfort during walking. Unlike plantar warts, nodules do not disrupt skin lines and are located deeper within the fascia rather than at the skin surface.

Diagnosis

Clinical diagnosis is typically straightforward for experienced podiatrists. Diagnostic ultrasound confirms the fascial origin, characterizes nodule dimensions, and rules out other differential diagnoses (ganglia, lipoma, foreign body granuloma). MRI provides superior soft tissue characterization and is reserved for atypical presentations or when surgical planning requires detailed anatomical mapping. Biopsy is rarely needed but confirms fibromatosis histology when diagnosis is uncertain.

Nonsurgical Treatment

First-line management includes offloading with custom orthotics incorporating plantar fascia accommodative padding, shoe modification guidance, and activity modification. Intralesional corticosteroid injection (triamcinolone acetonide 20–40mg) can reduce nodule tenderness but does not consistently reduce nodule size. Intralesional collagenase Clostridium histolyticum (Xiaflex) — FDA-approved for Dupuytren’s contracture — shows promise in plantar fibromatosis in case series with meaningful size reduction in 60–70% of treated patients. Radiotherapy (low-dose orthovoltage) is an emerging nonsurgical option for progressive plantar fibromatosis in patients who wish to avoid surgery, with studies showing stabilization or size reduction in >70% of cases.

Surgical Treatment and Recurrence

Surgical excision is reserved for rapidly progressing, functionally limiting fibromatosis unresponsive to conservative measures. Partial fasciectomy (limited nodule excision) carries recurrence rates of 60–100%, limiting its utility. Total plantar fasciectomy has lower recurrence rates but risks plantar nerve injury, painful scarring, and long recovery. Wide surgical margins correlate with lower recurrence but increase morbidity. Patients must be counseled that surgery is not curative and recurrence within 2–5 years is common.

Plantar Fibromatosis Care at Balance Foot & Ankle

Dr. Biernacki at Balance Foot & Ankle evaluates plantar fibromatosis with on-site diagnostic ultrasound and coordinates advanced imaging when surgical planning is required. Custom orthotic accommodation, intralesional injection, and surgical referral coordination are all available within the practice. Call (810) 206-1402 for a same-week evaluation.

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.