Plantar Fibromatosis (Ledderhose Disease): Fibrous Nodules in the Arch and Treatment Options

Quick answer: Treatment for plantar fibromatosis ledderhose disease treatment 3 follows a stepwise approach: 1) conservative care first (rest, ice, supportive footwear, OTC anti-inflammatories), 2) physical therapy and targeted exercises, 3) in-office treatments (injections, custom orthotics) if conservative fails at 4-6 weeks, 4) surgery for refractory cases. Most patients resolve at step 1 or 2. Call (810) 206-1402.

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 often progressive condition characterized by the growth of fibrous tissue nodules within the plantar fascia—the thick band of connective tissue spanning the bottom of the foot from the heel to the toes. These nodules are firm, non-tender to light touch but often painful when compressed during weight-bearing, and they are firmly adherent to the fascia beneath them (distinguishing them from cysts or ganglia, which are typically mobile). The condition affects both feet in approximately 25–50% of patients.

Causes and Associated Conditions

Plantar fibromatosis belongs to a group of fibromatosis disorders characterized by benign fibroblast proliferation in connective tissue. It is associated with Dupuytren’s contracture (similar fibrosis in the hand palm), Peyronie’s disease (fibrous plaque in penile tissue), and knuckle pads—collectively known as the “fibromatosis diathesis.” Genetic predisposition plays a role, as the condition tends to run in families. Additional risk factors include chronic alcohol use, liver disease, diabetes, epilepsy medications (particularly phenobarbital and phenytoin), and repeated micro-trauma to the plantar fascia.

Symptoms and Progression

Plantar fibromatosis typically presents as one or more firm, discrete nodules along the medial or central arch of the foot. Early nodules may be asymptomatic, discovered incidentally during a foot examination. As nodules enlarge, direct pressure from the ground during weight-bearing produces localized pain and discomfort. Shoe wear that concentrates pressure on the nodule (such as rigid-soled dress shoes) is particularly problematic. The condition does not become malignant but can progress slowly over years, with new nodules developing and existing ones enlarging.

Diagnosis

Diagnosis is typically clinical—based on the characteristic appearance and location of firm, fascia-adherent nodules in the plantar arch. Musculoskeletal ultrasound confirms the diagnosis, demonstrating hypoechoic nodules within the plantar fascia with no internal blood flow (helping distinguish from malignant soft tissue tumors, which are vascular). MRI provides more detailed characterization and is used when the diagnosis is uncertain or when surgical planning is required. Biopsy is rarely needed but confirms fibrous tissue histology when atypical features raise concern for malignancy.

Conservative Treatment Options

Most plantar fibromatosis is managed non-surgically. Custom orthotics with accommodative cutouts beneath the nodules redistribute plantar pressure away from the painful area, allowing comfortable ambulation. Softer shoe insoles and cushioned footwear reduce direct nodule compression. Stretching of the plantar fascia and calf muscles is recommended to reduce baseline fascial tension. Corticosteroid injection directly into nodules can temporarily soften and shrink them, reducing pain for months, though the effect is not permanent. Verapamil (a calcium channel blocker) gel applied topically has shown some benefit in early-stage disease. Radiation therapy is used in Europe for recurrent or progressive disease and is gaining acceptance in the United States.

Surgical Treatment and Recurrence Risk

Surgical excision of plantar fibromatosis nodules carries a significant recurrence risk—estimated at 25–50% after partial fasciectomy and up to 60–80% after simple nodule excision alone. For this reason, surgery is reserved for patients with severe, disabling pain that has failed extensive conservative management. When surgery is performed, wide local excision of the entire involved fascia (radical fasciectomy) achieves lower recurrence rates but requires longer recovery and carries risks of wound healing complications and nerve injury. Radiation therapy before or after surgery further reduces recurrence risk in appropriately selected patients.

Plantar Fibroma Treatment in Michigan

Plantar fibromatosis (Ledderhose disease) causes firm nodules in the arch of the foot that can become painful with walking. Dr. Tom Biernacki offers verapamil injections, custom orthotics, shockwave therapy, and surgical excision for plantar fibromas at Balance Foot & Ankle.

View All Treatment Options | Book Your Appointment | Call (810) 206-1402

Clinical References

1. Espert M, et al. “Ledderhose disease: a review.” Foot Ankle Spec. 2015;8(2):132-140.
2. Young JR, et al. “Ledderhose disease: plantar fibromatosis.” Radiographics. 2019;39(7):2143-2144.
3. Veith NT, et al. “Plantar fibromatosis — topical review.” Foot Ankle Int. 2013;34(12):1742-1746.

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Reviewed by Dr. Tom Biernacki, DPM, FACFAS

Board-certified foot & ankle surgeon · 3,000+ surgeries · @MichiganFootDoctors (950K+ subscribers)

Last reviewed May 11, 2026 · (810) 206-1402

When to See a Podiatrist

If foot or ankle pain has been bothering you for more than a few weeks, home care alone may not be enough. Balance Foot & Ankle offers same-week appointments at our Howell and Bloomfield Hills clinics — no referral needed in most cases. Bring your current shoes and a short list of symptoms and we’ll build you a treatment plan in one visit.

Call Balance Foot & Ankle: (810) 206-1402  ·  Book online  ·  Offices in Howell & Bloomfield Hills

What is Foot pain?

Foot pain is a common foot/ankle condition that affects mobility and quality of life. Understanding the underlying cause is the first step in successful treatment. Our podiatrists at Balance Foot & Ankle perform a hands-on biomechanical exam, review your activity history, and use diagnostic imaging when appropriate to identify the root cause—not just treat the symptom. Many patients have been told to “rest and ice” without a deeper diagnostic workup; our approach is different.

Symptoms and warning signs

Common signs of foot pain include pain that worsens with activity, morning stiffness, swelling, tenderness when palpated, and difficulty bearing weight. If you experience sudden severe pain, inability to walk, visible deformity, numbness or color change, contact our office the same day or visit urgent care—these can signal a more serious injury such as a fracture, tendon rupture, or vascular compromise. Diabetics with any foot wound should seek same-day care.

Conservative treatment options

Most cases of foot pain respond to non-surgical care: structured rest, supportive footwear changes, custom orthotics, targeted stretching and strengthening protocols, anti-inflammatory medications when medically appropriate, and in-office procedures such as ultrasound-guided injections. We also offer advanced therapies including MLS laser therapy, EPAT/shockwave, regenerative injections, and image-guided procedures. Treatment is sequenced from least invasive to most invasive, and we explain the rationale at every step.

When is surgery considered?

Surgery is reserved for cases that fail 3-6 months of well-structured conservative care, when there is structural pathology (severe deformity, complete tear, advanced arthritis), or when imaging shows damage that will not heal without intervention. Our surgeons have performed 3,000+ foot and ankle procedures and prioritize minimally-invasive techniques whenever appropriate. We discuss recovery timelines, return-to-activity milestones, and realistic outcome expectations before any procedure is scheduled.

Recovery timeline and prevention

Recovery from foot pain varies based on severity and chosen treatment path. Conservative cases often improve within 4-8 weeks with consistent adherence to the protocol. Post-procedural recovery may range from a few days (in-office procedures) to several months (reconstructive surgery). Long-term prevention involves footwear assessment, activity modification, structured strengthening, and regular check-ins with your podiatrist if you have a history of recurrence. We provide written home-exercise plans and digital follow-up support.

In-Office Treatment at Balance Foot & Ankle

If home treatment isn’t providing relief for your plantar fasciitis, our podiatry team at Balance Foot & Ankle can help with same-day evaluations and advanced in-office care.

Dr. Tom Biernacki, DPM

Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) 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 made him one of the most-followed foot & ankle educators on YouTube.