PLANTAR FIBROMATOSIS – A BENIGN CONDITION

Abstract

Plantar fibromatosis is a relatively rare disease compared to its counterpart in the hand. Though it is considered to be a part of Dupuytrens diathesis it has been less exhaustively studied to enable evidence based management strategies.

We followed up all patients presenting with plantar fibromatosis to our institute between 1980 and 2006, identifying 41 patients. 6 patients were lost to followup. Thirty-five patients with 60 involved feet were included in the study. There were 22 males and 13 females, all white Caucasians. The median age at presentation was 45 (19–63 years), and the median follow up was 10 years (2–25 years)

Twenty-one of our patients had palmar Dupuytren’s disease, six had knuckle pads, four had Peyronie’s disease, four had other superficial fibomatoses and two keloids. Six were diabetic, four had epilepsy of whom two took valproate and one phenobarbitone. Eight patients had a family history of fibromatoses.

The most common presentation was a painful lump (20); 13 patients had a painless lump (13) and two had only pain. All patients reported a proliferative phase of enlarging nodule size, often with pain, which lasted 1–4 years (median 2 years). Thereafter most patients reported improvement in symptoms (size of lump and pain) as well as function. As we came to recognise this, we treated most patients with symptomatic measures and observation only. At review, 17 patients considered their symptoms were improving, 14 were stable and only four had noticed deterioration. Seven patients, mostly early in the series, were treated by wide excision; six had recurrence at review although only one was symptomatic.

Plantar fibromatosis is a benign condition which stabilises and may improve after an initial proliferative phase lasting about two years Most patients require no intervention.