Plantar fibromatosis (Ledderhose disease)

What is plantar fibromatosis?

Plantar fibromatosis, also called Ledderhose disease, is a benign (not cancerous) overgrowth of the plantar fascia, the band of tissue under your foot¹². It forms one or more firm, slow-growing lumps, called plantar fibromas, usually along the arch². Plantar fibromas are usually benign, with a very low chance of being cancer².

It's rare. It mostly affects middle-aged people, and it has been reported in children, but how common it is isn't well known³. It can affect one foot or both, and both feet are involved in about a quarter of cases⁴. It sometimes occurs alongside Dupuytren's disease, a similar thickening in the palm of the hand⁵.

What causes it, and who gets it?

The cause isn't known². It has been linked with, though not shown to be caused by, older age, injury to the foot, diabetes, epilepsy and anti-seizure medicines, alcohol, liver disease and smoking⁴³. Men are affected about twice as often as women⁴, and a family tendency may play a part⁴.

A link isn't a diagnosis. Having one of these doesn't mean you'll develop a lump, and a lump on your sole shouldn't be put down to fibromatosis until it has been checked.

What does it feel like, and how is it diagnosed?

Most people notice a firm lump in the arch, often 0.5–3.0 cm across, that grows slowly³. It's often painless at first and may become sore as it enlarges³. Pressure from shoes over the lump is a common cause of pain², and tight shoes, walking barefoot and standing for long periods can make it worse³.

A podiatrist or doctor can usually diagnose it from your history and by feeling the lump, and X-rays aren't routinely needed⁶. An ultrasound or MRI scan can help confirm it, and a biopsy (a small tissue sample) is sometimes taken if cancer is a concern³. Other problems, such as plantar fasciitis, tarsal tunnel syndrome and a stress fracture of the heel bone, can cause sole or heel pain and can occur at the same time³, so try not to self-diagnose sole pain⁷.

What helps first?

Care usually starts with simple steps: learning about the condition, changing your footwear, adjusting your activity (especially avoiding high-impact sports), and insoles, also called orthoses, to take pressure off the lump⁸. A lump that isn't causing pain can be left alone and watched⁹.

Choose comfortable shoes that don't press on the lump. If you're given orthoses, build up wearing them as your podiatrist advises, and keep them out of sport or vigorous activity until you've finished the wearing plan and they feel fully comfortable¹⁰. If you have diabetes, avoid shoes with seams that can rub your foot¹⁰. A podiatrist can help if the lump is limiting your activity¹¹.

The evidence behind these steps is weak, and results are debated¹, so review how you're going with your podiatrist.

What helps if that isn't enough?

If the lump is still sore or limiting you after sensible self-care, see your GP or a podiatrist. They can check again for anything else going on¹³ and talk through other options. Shockwave therapy can be considered, though the evidence for it is limited¹¹. Radiotherapy may be worth considering for early-stage fascial fibromatosis, the wider group of conditions this belongs to¹², and surgery is another option your doctor can discuss¹.

It isn't clear yet how well each option works or how often lumps return, because better trials are still needed¹. It's worth hearing the benefits and risks before any procedure.

What's the outlook, and can it come back?

Plantar fibromatosis is benign and usually grows slowly⁸. Many lumps stay painless, but some become sore and get in the way of standing, walking or running⁸. Occasionally it is more aggressive and causes the toes to tighten or curl (contractures)⁵. A lump that grows or becomes painful needs a further look, sometimes with a scan².

It isn't clear yet whether anything prevents a lump coming back after treatment or stops it growing. What you can do is keep an eye on it and have changes checked.