Plantar Fibromatosis

- See:
         - Fibroma
         - Desmoplastic Fibroma 
         - Soft Tissue Menu

- Discussion:
    - refers to multiple fibrous benign tumors which are locally aggressive;
    - these are more aggresive than solitary fibroma;
    - these lesions often develope in the proximal limbs or the trunk;
            - in abdomen, the tumor is called a desmoid tumors;
            - in the foot, plantar fibromatosis is common;
    - although generally superficial, tumors are locally invasive, frequently involving adjacent neurovascular structures;

- Non Operative Treatment:
    - begins w/ construction of a well molded, padded shoe & orthosis;
    - transference of weight away from prominent nodules is important;
    - may require custom-made insoles;
    - radiation therapy:
           - may be used as an adjunct to surgical excision in treatment of aggressive fibromatosis;

- Surgical:
    - indications for surgical treatment:
           - major indication for operative intervention is pain;
           - when nodules become large and painful enough to be disabling while patient is standing or walking;
    - plantar fibromatosis: operative treatment:
           - these tumors may involve neurovascular structures as well as infiltrating surrounding muscle;
           - care must be taken to place the incision away from wt-bearing region;
           - use a longitudinal medial incision  use longitudinal, s-shaped incision made on plantar surface of foot;
                  - incision can be made two centimeters posterior to head of first metatarsal, w/ extension posterolaterally, then posteromedially, & again posterolaterally,
                            finishing anterior to weight-bearing surface of calcaneus;
           - total excision of the fascia is necessary to reduce the chance of recurrence;
           - in some cases the skin will be heavily adherent to the mass, which then requires removal of a portion of the skin along with the mass;
    - resection & recurrence:
           - recurrence after incomplete excision is very common;
           - consider wider excision - even if this will require STSG;
           - use at least 2-cm  margin of normal fascia proximal and distal to nodule;
           - recurrance are difficult to distinguish from scarring of previous excisions, thus making excision even more hazardous;
           - adjuvant radiation therapy reduces that recurrence rate after marginal or even after intracapsular excision;
           - consider using of XRT as adjunct to surgical excision

Current Concepts Review.  Plantar Fibromatosis.

Radiation therapy for aggressive fibromatosis. The Experience at the University of Florida.

Musculoaponeurotic fibromatosis. A report of 28 cases and review of the literature.

Chemotherapy for children with aggressive fibromatosis and Langerhans' cell histiocytosis.

Plantar fibromatosis: an immunohistochemical and ultrastructural study.  

Masses of the foot closely related to the plantar fascia.

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, June 20, 2012 1:21 pm