Plantar Fibromatosis

Excerpt

Plantar fibromatosis is a benign, fibroblastic, proliferative connective tissue disorder of the superficial plantar aponeurosis. This condition, also known as Ledderhose disease, belongs to a family of similar diseases, including Peyronie and Dupuytren diseases, first described in 1610 by Plater. George Ledderhose, a German physician, initially described the disorder in 1897 after observing 50 patients with painful sole lesions.

Ledderhose disease is diagnosed by identifying nodules within the central or medial plantar fascia bands. Patients with plantar fibromatosis often present with sole lumps, usually in the arch area. These masses may be singular or multiple and may occur unilaterally or bilaterally. Onset is slow, and patients usually present with pain and swelling in the medial, non-weight-bearing plantar foot surfaces after the disease becomes locally aggressive.

The plantar aponeurosis (plantar fascia) is a thick connective tissue band supporting the foot arch composed primarily of collagen fibers arranged in a dense, fibrous matrix. This fibrous structure extends from the heel bone (calcaneus) to the toe bases and helps absorb shock during walking and running (see Image. Plantar Aponeurosis). The plantar fascia is divided into 3 distinct bands: medial, central, and lateral. The medial band is the thickest and strongest portion, while the lateral band is thinner and less prominent. These bands work together to distribute forces evenly across the foot and maintain the arches during movement. Additionally, the plantar fascia is richly supplied with blood vessels and nerves, contributing to its ability to heal and transmit sensory information.

In plantar fibromatosis, nodules or fibrous growths may develop within the plantar fascia, typically in the foot's central or medial portion, leading to pain, discomfort, and limited mobility. Adjacent anatomical structures relevant to plantar fibromatosis include the foot muscles and tendons, such as the flexor digitorum brevis and abductor hallucis, which interact closely with the plantar fascia. Nerves supplying sensory information to the foot, such as the medial and lateral plantar nerves, and blood vessels providing oxygen and nutrients to the tissues are also important considerations in the anatomy of plantar fibromatosis.