II. Definitions

  1. Plantar Fibromatosis (Plantar Fibroma)
    1. Fibrous proliferation of the plantar fascia and plantar aponeurosis
    2. Similar to Dupuytren's Contracture of palm

III. Risk Factors

  1. Dupuytren Contracture
  2. Peyronie Disease

IV. Symptoms

  1. Slow enlargement of a painless Subcutaneous Nodule
  2. Eventually becomes tender and painful with walking or prolonged standing

V. Signs

  1. Palpable Nodule or thickening of the plantar fascia
  2. Involves medial half of middle of plantar fascia
  3. Contractures rarely occur
  4. Bilateral involvement in 20 to 50% of cases

VI. Differential Diagnosis

VII. Imaging

  1. Ultrasound
    1. Hypoechoic to isoechoic fusiform Nodules
  2. MRI
    1. Well defined mass with similar intensity to Muscle on T1 imaging
    2. Broad base at the superficial fascia

VIII. Management

  1. Molded Orthotic
    1. Allows transfer of weight away from Nodule
  2. Intralesional Corticosteroid Injection
  3. Surgery: Subtotal fasciectomy with wide excision
    1. Indicated when weight bearing becomes painful
    2. Often recurs after excision

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