Plantar fibromatosis (plural: fibromatoses), also known as Ledderhose disease, refers to a benign fibroblastic proliferation of the plantar fascia. It is classified as a type of musculoskeletal fibromatosis.
Plantar fibromatosis can be seen in both children and adults, although there is a recognized male predilection (M: F of 2:1).
Nodules or masses of plantar fibromatosis are typically located in the middle to the medial aspect of the plantar arch and may extend to involve the skin or deep structures of the foot. Lesions may be symptomatic because of a mass effect or invasion of adjacent muscles or neurovascular structures. In contrast to Dupuytren disease, flexion deformities usually do not occur 9.
Plantar fibromatosis is associated with other fibroproliferative disorders such as:
- Dupuytren disease (also known as palmar fibromatosis) is seen in ~40% (range 10-65%) of patients
- Peyronie disease
Unfortunately, the exact etiology of plantar fibromatosis is not well understood 4.
Often seen as a hypo to mixed echogenicity 3, discrete, fusiform, multinodular thickening of the plantar fascia located separately to the calcaneal insertion 1. Most (~90%) do not demonstrate intrinsic vascularity on Doppler ultrasound 1.
Typically relatively well-defined region of fusiform or multinodular thickening of the plantar fascia, not involving the calcaneal origin
- T1: iso to low signal compared with muscle 1,2
- T1 C+ (Gd): demonstrates variable contrast enhancement 4
- T2: low to intermediate signal compared with muscle 1,2
Treatment and prognosis
Initially, orthotics and local steroid injection are the treatment of choice. Radiotherapy is the most efficient with the least recurrence rate 10. Local excision with a wide margin is the definitive treatment for painful or disabling lesions, but recurrences are common 11.
Possible considerations include
soft tissue sarcoma
- in some cases, it might be difficult to differentiate
- typically sarcomas are aggressive and demonstrate low signal on T1WI and high signal on T2WI with intense and sometimes heterogeneous contrast enhancement
- plantar fasciitis (especially if nodular): affects the proximal aspect with fusiform thickening of the fascia
History and etymology
Plantar fibromatosis is sometimes referred to as Ledderhose disease after Georg Ledderhose (1855-1925), German surgeon, who first described it in 1894 7,12.
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- 5. Lee JC, Thomas JM, Phillips S et-al. Aggressive fibromatosis: MRI features with pathologic correlation. AJR Am J Roentgenol. 2006;186 (1): 247-54. doi:10.2214/AJR.04.1674 - Pubmed citation
- 6.Quinn SF, Erickson SJ, Dee PM et-al. MR imaging in fibromatosis: results in 26 patients with pathologic correlation. AJR Am J Roentgenol. 1991;156 (3): 539-42. AJR Am J Roentgenol (abstract) - Pubmed citation
- 7. Ledderhose G (1894). "Über Zerreisungen der Plantarfascie". Arch Klin Chir 48: 853–856.
- 8. Dinauer PA, Brixey CJ, Moncur JT et-al. Pathologic and MR imaging features of benign fibrous soft-tissue tumors in adults. Radiographics. 27 (1): 173-87. doi:10.1148/rg.271065065 - Pubmed citation
- 9. Hougeir FG, Elston DM, Plantar Fibromatosis Clinical Presentation. Medscape. updated 14th May 2014. emedicine link
- 10. Schurer, A., Manley, G., Wach, W. (2016) International Patient Survey (Part 2: Ledderhose Disease) in Paul M. N. Werker, Joseph Dias, Charles Eaton, et al. Dupuytren Disease and Related Diseases - The Cutting Edge. (2016) ISBN: 9783319321998 Switzerland: Springer pp 371-5
- 11. van der Veer WM, Hamburg SM, de Gast A, Niessen FB. Recurrence of plantar fibromatosis after plantar fasciectomy: single-center long-term results. (2008) Plastic and reconstructive surgery. 122 (2): 486-91. doi:10.1097/PRS.0b013e31817d61ab - Pubmed
- 12. Al Aboud AK. Eponyms in dermatology literature linked to fibromatosis. Our Dermatol Online. 2018;9(1):108-109. DOI: 10.7241/ourd.20181.37. http://www.odermatol.com/odermatology/20181/37.Eponyms-AlAboudK.pdf
- 13. Robbin MR, Murphey MD, Temple HT, Kransdorf MJ, Choi JJ. Imaging of musculoskeletal fibromatosis. (2001) Radiographics : a review publication of the Radiological Society of North America, Inc. 21 (3): 585-600. doi:10.1148/radiographics.21.3.g01ma21585 - Pubmed