Plantar fibromatosis presents as one or more palpable fibrous nodules within the plantar fascia, commonly causing pain with weight-bearing. Because the condition is benign, treatment is directed at symptom control: resolving plantar pain and eliminating the palpable nodule. When first-line conservative measures do not reach these goals, a structured next-line regimen is indicated.
This protocol applies after conservative management has been trialled — options in that line include intralesional steroid injections, verapamil (topical or intralesional), extracorporeal shock wave therapy, and tamoxifen, among others — and has failed to achieve the expected goals: meaningful reduction in plantar nodule size and resolution of plantar pain with ambulation. Failure on these endpoints is the trigger for escalation.
DOI: 10.2147/ORR.S154289
Wide excision involves the removal of a 2–3 cm margin of surrounding tissue along with the nodule.
Removing the entire plantar fascia has the lowest rate of recurrence, at approximately 0%–50%.
Some surgeons have also advocated for the use of partial fasciectomy, noting the ability to remove diseased tissue along with a cuff of normal fascia with less presumed morbidity than total fasciectomy.
Adjuvant radiotherapy has been proposed as a solution to fibroma recurrence.
Given the benign nature of this condition, surgical management has generally been reserved for pain relief.
Today, indications for surgery include both pain refractory to conservative treatments as well as local aggressiveness of the lesion.
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