Plantar fibromas are small, benign growths or nodules that are located deep within the fascia. They begin to develop along the bottom of the foot between the skin and the outermost layers of the muscles. Fibromas can begin to develop in your 20s but can also occur as late as your 60s. Most fibromas remain small, rarely becoming larger than an inch in size. It is believed that genetics plays a role in the development of fibromas. Plantar fibromas may be present in your feet for long periods of time without you even realizing they are there. It's only when they grow large enough to start causing discomfort do you realize the growths are present.
For most people, the symptoms of plantar fibromas consist of extreme pain and discomfort located in the instep or arch area of the foot. The small growth is normally located somewhere within the arch, between the ball of the foot and the heel. The small mass will appear as an abnormality in the arch of the foot. The contour will be slightly altered and it will be extremely tender to the touch. The pain and discomfort of plantar fibromas start gradually and continues to worsen as the mass grows.
Most fibromas only grow to less than an inch in size, while those associated with plantar fibromatosis can grow to an inch or more, extending through several layers of tissue. When a fibroma grows near a nerve, it can eventually start to cause some degree of numbness in the area. If you believe you may have a plantar fibroma or fibromatosis, contact Dr. Fihman as soon as you begin to feel any type of discomfort. She can evaluate the condition and determine the best treatment option for your individual case.
Plantar fibromas have no known cause, except for the genetic factors that have been noticed. While doctors have identified the genetic link that causes fibromas to be passed down through the family, they are unsure of which gene contains the defect. If you make the choice to have a plantar fibroma removed, there is a small risk that the genetic defect that caused it, might cause it to grow back. Soft masses in the foot can have a wide variety of causes. Infections, cysts, and swollen or ruptured tendons are also possible, but normally don't cause as much pain and discomfort as a fibroma.
Nerve or fatty tumors can also grow in within the fascia of the foot. Previous injuries that involved penetration of the foot may also lead to the formation of these types of masses. While trauma to the foot may be a factor in the growth of nerve and fatty tumors, it doesn't seem to play any type of role in the development of fibromas, or the faster-growing masses associated with fibromatosis. By performing a thorough evaluation, Dr. Fihman will be able to determine which type of mass or tumor you have and provide you with an accurate diagnosis.
A clinical exam, along with an x-ray or MRI is usually required to make an accurate diagnosis. Biopsies are rarely used to diagnose this type of growth. Dr. Fihman will palpate the bottom of your foot, placing pressure on any area that feels as if an abnormality is present. If you feel any pain or discomfort, she will note the problem and ask you to return in a few weeks to again observe the situation. If the problem still exists or continues to worsen over that period of time. An x-ray or MRI will be ordered to determine the exact location and size of the mass. If the mass appears to be calcified, it may be a more serious condition, synovial cell carcinoma. If this is the case, other measures will need to be taken immediately.
Plantar fibromatosis is a more aggressive form of the condition. With fibromatosis, the mass grows much faster and larger than a fibroma. It can also involve deeper levels of muscle tissue and wrap around the nerves that go to the toes. This can result in more widespread pain and discomfort. The masses associated with fibromatosis often grow back if they are surgically removed.
Treatment and Recovery
In the majority of diagnosed plantar fibromas, Dr. Fihman will observe the mass to determine whether it is still growing. Orthotics that take the pressure off of the insole of the foot may be used to relieve the pressure and intense pain. Steroid injections are sometimes used to relieve the pain and minimize any inflammation that may be present. The fibromas may begin to shrink after steroids have been used, but will return to normal size after the medication wears off. Physical therapy is also beneficial for keeping the area flexible and maintaining mobility.
The use of orthotics and physical therapy is a beneficial combination for many reasons. While steroids and anti-inflammatories can be effectively used to reduce the size and inflammation associated with the condition, orthotics, and physical therapy work together to support the structure of the foot and reduce the pressure that is being placed on the mass with each step. Orthotics are designed to fit the exact curvature of the bottom of your foot. When fibromas are present, orthotics are used to minimize the pressure over the fibroma while dispersing over the rest of the foot.
Physical therapy is used to keep the muscles, tendons, and ligaments, that form the soft structure of the foot strong and flexible. When a fibroma forms it can cause the soft tissues to tighten, causing intense pain and discomfort. Exercises used during a physical therapy session involve stretches that flex and contract the arches and curves of the feet. This accomplishes two things. First, it maintains flexibility and range of motion. Secondly, it increases blood flow to the area. Increases blood flow means additional oxygen and nutrients that the tissues need to remain healthy. The more you exercise your feet, through stretching and walking, the more your circulation will improve and the more oxygen and nutrients your feet will receive in the process.
Surgery is also a possible treatment option if the fibroma is located in an area where the other treatment options are not effective. Most of the risks associated with this type of procedure involve the healing of the wound and not the actual removal of the fibroma. The procedure is rather simple and can be performed in a short amount of time. Although there is some risk associated with the nerves that affect the toes, the procedure allows for a speedy recovery if proper wound care is observed. Regular physical therapy will hasten the healing process and keep the foot as pliant as possible. Recovery can range between four to six weeks, depending on the type of care received and how well you follow Dr. Fihman's orders. After any type of foot surgery, you need to take proper care of your feet so that you don't aggravate the injury or slow down the healing process. Take a few minutes each day to soak your feet in a tub of warm water and make sure to always wear comfortable shoes that support the arches of your feet. Always report any problems you may experience to Dr. Fihman as soon as they occur.
Dr. Fihman offers concierge services to her patients who live throughout the Los Angeles and Beverly Hills area. She offers this service to many of her clients that have difficulty finding a way to see her in her office. Some may not have transportation, while others may not be able to physically move well enough to make it into her office. She has a wide variety of mobile equipment that she can take with her to diagnose and treat many different types of foot conditions. She can effectively perform x-rays, offer injections, and perform a wide variety of procedures for you in the comfort of your own home. If you believe you may have a fibroma or fibromatosis, Dr. Fihman can perform the evaluation in your home and provide you with an accurate diagnosis.
Dr. Leonora Fihman is a board-certified podiatrist who specializes in the diagnosis and treatment of health conditions and injuries that affect the feet and ankles. She also performs podiatric surgery. After graduating from the New York College of Podiatric Medicine in 2009, she moved to the Encino, California area and began to work on her postgraduate degree at Kindred Rancho Hospital. She continued to study every aspect of the field of podiatry, especially the reconstruction of the foot in both children and adults. Dr. Fihman holds memberships in many different medical societies and organizations. As part of her certification, she continues to receive education in a variety of areas concerning podiatric medicine.