Plantar Fibromatosis (Ledderhose Disease): Current Management and Emerging Treatments

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

Plantar fibromatosis — nodular thickening of the plantar fascia from fibroblastic proliferation producing firm plantar nodules — is a benign but often symptomatic condition that is frequently confused with other plantar pathology. Unlike Dupuytren contracture of the hand (to which it is closely related pathologically), plantar fibromatosis rarely produces toe flexion contracture — but plantar nodular pain with walking is the predominant complaint and can be functionally limiting.

Clinical Presentation

Plantar fibromatosis presents as one or multiple firm, non-tender or mildly tender nodules within the plantar fascia, most commonly in the medial plantar arch region. Unlike plantar fasciitis, the pain is typically over the nodule itself rather than at the calcaneal origin, and morning first-step pain is not a characteristic feature. The condition is bilateral in 20–25% of cases. Associated conditions include Dupuytren contracture of the hand and Peyronie’s disease — together comprising the “fibromatosis triad” that suggests a systemic fibroproliferative diathesis. Diabetes, epilepsy treated with phenobarbital, and chronic liver disease are associated risk factors.

Conservative Management

Padding and offloading with accommodative orthotics bearing a relief cutout beneath the nodule is the foundation of conservative treatment — reducing direct pressure on the nodule during stance. Intralesional corticosteroid injection reduces nodule tenderness and size in approximately 50% of cases but does not eliminate the nodule. Intralesional collagenase injection (used successfully in Dupuytren contracture) is under investigation for plantar fibromatosis but lacks reliable evidence at this time. Radiation therapy — low-dose external beam radiation — has been reported to reduce nodule size and pain in refractory cases in European literature, though experience in the U.S. is limited.

Surgical Management

Surgical excision carries a high recurrence rate (50–60% at 5 years) and risks plantar wound complications, making it a last resort for truly refractory, disabling cases. The recurrence rate is lower with wide excision (including a margin of normal plantar fascia surrounding the nodule) than with simple nodulectomy, but complete excision of the entire plantar fascia substantially reduces recurrence at the cost of arch instability and prolonged recovery. Dr. Biernacki at Balance Foot & Ankle evaluates plantar nodular pathology with clinical examination and ultrasound confirmation of fibromatosis, and provides comprehensive conservative management. 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

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.