Plantar fibromatosis M72.2

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Aponeurosis fibrosa plantaris; Fibroma juveniles aponeurotic; Foot sole fascia contracture; Leather trousers M.; M. Ledderhose; Morbus Ledderhose; plantar fibromatosis

History
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Leather pants, 1894

Definition
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A disease of the sole of the foot corresponding to Dupuytren's contracture, but occurring much less frequently, due to fibrous proliferation ( cutaneous fibromatosis) of the aponeurosis, possibly genetically determined. Plantar fibromatosis is a therapy-resistant, benign hyperproliferative disease of the plantar fascia of unknown etiology.

Manifestation
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Mainly occurring in men (30.-60. LJ). Manifestation in children or adolescents is rare.

Localization
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Middle area of the planta (Arcus plantaris).

Clinical features
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Clinically there are slow-growing, ligamentous or even roundish-oval, mostly palpatorily well definable nodules on the medial and central ligaments of the plantar fascia (Carroll P et al. 2018). In 30-40% of cases, bilateral involvement of the plantar fascia is evident. The node(s) can be palpated well and is usually sensitive to pressure. Painful difficulty in walking is possible with more extensive training.

Histology
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Mostly subcutaneously localized, sharply defined, vascularly poor, nodular tumor consisting of monomorphic, spindle-shaped to oval cells with bright nuclei and small prominent nucleoli. The cells are combined to form interwoven strands.

Immunohistology: Vimentin and desmin positive; spot-like activity towards alpha-actin; MIB-1 occasionally positive.

Therapy
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Treatment depending on the degree of severity according to the therapy of Dupuytren's contracture (see Dupuytren's contracture below). The recommended therapy is fasciotomy. Risk of recurrence (up to 60%) with isolated removal of the node. Operative procedure only by experienced surgeons!

The subtotal fasciotomy is an optional therapy option (Souza BG et al.2016). Radiation therapy represents another therapy

(Seegenschmiedt MH et al. 2015)

Literature
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  1. Carroll P et al (2018) Plantar fibromatosis: Pathophysiology, Surgical and Nonsurgical Therapies: An Evidence-Based Review.
  2. Foot Ankle Spec doi: 10.1177/1938640017751184.
  3. de Almeida HL Jr et al (2001) Plantar fibromatosis with marked cutaneous involvement. Dermatologist 52: 236-239
  4. de Bree E et al (2004) Incidence and treatment of recurrent plantar fibromatosis by surgery and postoperative radiotherapy. On J Surgery 187: 33-38
  5. Graells Estrada J et al (2003) Familial plantar fibromatosis. Clin Exp Dermatol 28: 669-670
  6. Ledderhose G (1895) About consequences and treatment of finger injuries. In: R.Volkmann (Hrsg) Collection Klin. Vortr├Ąge, Leipzig
  7. Schonauer F et al (2012) Calcifying aponeurotic fibroma of the distal phalanx. J Plast Reconstr Aesthet Surg 66:e47-49.
  8. Seegenschmiedt MH et al. (2015) German Cooperative Group on Radiotherapy of Benign Diseases (GCG-BD). DEGRO guidelines for the radiotherapy of non-malignant disorders: part III: hyperproliferative disorders. Radiotherapy oncol 191:541-548.
  9. Souza BG et al(2016) Surgical Treatment of a Case of Ledderhose's Disease: A Safe Plantar Approach to SubtotalFasciectomy. Case Rep Orthop doi: 10.1155/2015/509732.

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Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020