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Small mass in plantar fascia/tendon sheath

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Gillian Pennington, Aug 28, 2012.

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    Please help! Any information would be valued.
    I saw a new patient, a healthy 57 year old with no history of athritic conditons. She has two masses, bilaterally, in the plantar soles. (one mass in each foot). It is difficult to tell whether the mass is in the flexor hallucis sheaf, or in the medial part of the plantar fascia.
    The mass is about 1 cm in diameter, and feels hard. It can be moved.
    The patient has had these for about two years. They have grown larger, and are now painful.
    The patient is pes planus. She is putting pressure on these masses when weight bearing.
    I have seen these masses before, and in the same position, but not bilaterally before.
    I have asked the patient to return to her family doctor for more investigation. (MRI?)
    WHat are they? Will they need surgical excision, or can they be removed some other way.?
    I discussed footwear, orthotics with patient, and placed felt beneath arch.
    Please help with any other information.
  2. Admin2

    Admin2 Administrator Staff Member

  3. efuller

    efuller MVP

    Where on the foot is the bump. In the medial arch the FHL tendon is deep to the fascia and I would be surprised that you could palpate the tendon through the fascia. Plantara fibroma?

  4. Thanks Eric, Yes you're correct, the mass is just below the surface, so probably in the plantara fibroma. What will the correct course of action be?
  5. Sally Smillie

    Sally Smillie Active Member

    I had a patient with these once, years ago. He was late 30's, tradesman, 2-3 lesions bilaterally. They turned out to be turgid pus filled lesions that were excised???? possibly. I referred to the pod surgeon for an opinion.
    Unfortunately the way our clinics used to be arranged (and professional correspondance) I personally never saw him after that or heard what action was taken, so sadly cannot offer much more than that. I would be interested in what happens to your patient.
  6. efuller

    efuller MVP

    The problem with plantar fibromas is that they are a mass lesion. In someone without a plantar fibroma you could tape a wad of putty under the arch and create the same discomfort. If the problem is the mass, you have to make sure there is nothing touching it when the foot is in the shoe.

    Plantar fibromas are usually benign, but can grow and surgical excission may be needed.

  7. LSM

    LSM Welcome New Poster

    Hi Gillian,
    Have you considered Dupuytren's contracture of the plantar fascia, in the mists of time of my study, and the experience of one patient that this is a cause of lumps on the plantar surface. I am sure more learned people on this site will have a better understanding of this condition
  8. jane.e.benson

    jane.e.benson Active Member

    I've had two patients with this condition. Both patients i treated with 7mm swansdown on foam pads with central cut outs to relieve pressure and with one patient the body totally re-absorbed the fibromas ( this lady had larger, but softer fibromas ) It took quite a few months, wearing them constantly to start with. The other had great comfort but, although shrunken, still has small nodules which don't cause her any discomfort. ( this lady has a mild Dupuytren's contracture in her hands).
  9. Sally Smillie

    Sally Smillie Active Member

    often with Duputryns contractures they can have them in palmar fascia as well, so worth checking hands too
  10. Ryan McCallum

    Ryan McCallum Active Member

    I would agree with plantar fibromas. I see these fairly frequently. I tend to treat initially with steroid injections and refer on for offloading insoles. We seem to get good results with this. Failing significant reduction in size/symptoms, I will consider for surgical excision although thankfully I rarely ever excise them. Recurrence is high following surgical excision.
  11. I agree with Ryan that this is likely a plantar fibroma (plantar fibromas are very easy to diagnosis once you have seen a hundred or so of them). I will perform intralesional injections of 80 mg/ml Depomedrol for symptomatic plantar fibromas which will nearly always shrink the fibromas by 50% within 4-6 weeks. I use surgical excision (radical excision removing the whole plantar fascia) only for very large fibromas which are starting to hit the ground or causing painful symptoms. I don't excise smaller fibromas now since they tend to recur if small excisions are performed, but rather prefer occasional cortisone injections to keep them asymptomatic.

    Hope this helps.:drinks
  12. Peter1234

    Peter1234 Active Member

    I had an elderly gentleman in a few months ago. He had a lump just below the surface of the skin overlying the meidal plantar fascia that was tender when walking. I suggested he massage the plantar fascia overlying the 'fibroma'. I saw him three weeks later, and the lump had disappeared.

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