Plantar Fibroma: A Lump in the Arch of the Foot

01Basics

What a plantar fibroma is

The plantar fascia supports the arch of the foot. A plantar fibroma is a thickening of this tissue that forms a nodule. It is not cancer and does not spread, but it may slowly enlarge and new nodules can appear.

02Symptoms

Symptoms

• A firm lump in the arch of the foot.
• Often painless at first.
• Pain when walking barefoot or standing for long periods.
• Discomfort when shoes or insoles press on the lump.
• Several lumps in plantar fibromatosis.

03Ledderhose

Plantar fibromatosis (Ledderhose disease)

In plantar fibromatosis, one or more nodules develop, sometimes in both feet. It is related to Dupuytren’s contracture, a condition causing thickening in the palm of the hand, and some people have both. Unlike Dupuytren’s, it rarely causes the toes to curl.

04Causes

Causes and risk factors

• Genetic factors and family history.
• Dupuytren’s contracture or other fibromatosis.
• Diabetes and liver disease.
• Epilepsy and some anti-epileptic medicines.
• Alcohol.
• Repeated minor trauma to the foot is suspected but unproven.

05Diagnosis

Diagnosis

A doctor, podiatrist or physiotherapist examines the foot and feels the nodule within the plantar fascia. Ultrasound or MRI confirms the diagnosis, measures the size and distinguishes it from other lumps such as cysts, neuromas or, rarely, soft tissue tumours.

06Not fasciitis

Plantar fibroma vs plantar fasciitis

Plantar fasciitis causes heel pain, worse with the first steps in the morning, without a lump. A plantar fibroma is a lump in the arch. Both involve the plantar fascia, and some people have both.

See plantar fasciitis symptoms and heel pain.

07Insoles

Insoles and footwear

• Soft insoles with a cut-out or recess under the nodule.
• Custom orthotics to redistribute pressure.
• Cushioned, supportive shoes.
• Avoid walking barefoot on hard floors.
• Avoid shoes with firm arch supports that press on the lump.

08Stretches

Stretches and exercises

• Calf stretches against a wall with the knee straight and bent.
• Plantar fascia stretch: pull the toes back gently.
• Toe spreading and towel curls for foot strength.
• Rolling a ball under the foot, avoiding direct pressure on the nodule.

See flat feet exercises.

09Injections

Injections and other treatments

Steroid injections may reduce pain and sometimes size temporarily. Other options, such as radiotherapy, shockwave therapy or collagenase injections, have been studied with variable results and are used in specialist centres.

10Surgery

Surgery

Surgery is considered for large, painful nodules that do not respond to other treatments. Removing part or all of the plantar fascia may relieve symptoms but can flatten the arch, and recurrence is common, especially with partial removal. Recovery can take several weeks.

11Living

Living with a plantar fibroma

Many people manage well with good footwear and insoles. Monitoring the size of the nodule and noting changes in pain helps decide whether further treatment is needed.

12Work

Standing jobs and sport

People who stand or walk for long periods at work can reduce pain with cushioned, supportive shoes, a custom insole with a recess under the nodule, anti-fatigue mats and short sitting breaks. Runners and walkers can usually continue with suitable footwear, reducing distance temporarily if the lump becomes sore.

13Monitoring

Keeping track of changes

Measuring the lump or taking photographs every few months helps you notice growth. Most fibromas grow slowly or not at all. Rapid growth, a lump larger than about 5 cm, deep location or new pain should be reviewed, sometimes with repeat imaging.

15Summary

Key points to remember

• A plantar fibroma is a benign lump in the arch of the foot.
• It is related to Dupuytren’s contracture.
• Insoles with cut-outs and cushioned shoes ease pain.
• Surgery is a last resort because recurrence is common.