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Plantar Fibroma/Fibromatosis. Fibroma:Benign, self-liming proliferation of fibroblasts, producing collagen, most being subcutaneous single lesionsOccur at any ageLesions may recur after excision. Plantar Fibroma/Fibromatosis. Fibromatosis:Group of diseases demonstrating infiltrative growth that makes them less discrete than fibromasMultiple lesionsAffects medial fascial slip.
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1. PLANTAR FIBROMA/FIBROMATOSIS: A CASE PRESENTATION
ERIC BEATTY, DPM
3. Plantar Fibroma/Fibromatosis Fibromatosis:
Group of diseases demonstrating infiltrative growth that makes them less discrete than fibromas
Multiple lesions
Affects medial fascial slip
4. Plantar Fibroma/Fibromatosis Possible Onset:
Aggressive healing response to small tears in the plantar fascia (over repair)
Congenital deformity
Secondary to history of puncture injuries to the foot
5. Plantar Fibroma/Fibromatosis A 56 y/o female presents with complaint of left foot pain for duration >6 months
Palpable nodule on left medial plantar arch
Progressed gradually in size
Painful upon ambulation, palpation, and shoe gear
Previous conservative treatment ineffective
6. Plantar Fibroma/Fibromatosis PMH: HTN
PSH: c-section, fibroid surgery, tonsilectomy, tubal ligation
Meds: atenolol 25mg, MVI, calcium supplement
Allergies: penicillin
Social Hx: negative
Etoh/Tobacco: negative
Height: 5’1’’ Weight: 164 lb
7. Plantar Fibroma/Fibromatosis Observation: 3cm subcutaneous soft tissue mass just proximal to the 1st metatarsal head extending into the mid arch area of the medial plantar surface of left foot.
8. Plantar Fibroma/Fibromatosis
9. Plantar Fibroma/Fibromatosis Differential Diagnosis:
Foreign objects
Dermatofibroma (a fibroma of the skin)
Abscess
Neuroma
Histiocytoma
Fibrosarcoma (rare in foot)
10. Plantar Fibroma/Fibromatosis Diagnostic Imaging:
Ultrasound
Nodules are hypoechoic and appear as droplets of wate adhering to the plantar surface of the fascia
MRI
T1-weighted spin-echo (low signal intensity)
T2-weighted spin-echo (low to intermediate signal intensity)
11. Plantar Fibroma/Fibromatosis MRI T1-weighted spin-echo (low signal intensity)
12. Plantar Fibroma/Fibromatosis MRI T2-weighted spin echo images (low to intermediate signal intensity)
13. Plantar Fibroma/Fibromatosis Ultrasound (nodule is hypoechoic and appear as droplets of water)
14. Plantar Fibroma/Fibromatosis Procedure:
Curvilinear incision over plantar palpable mass
Sharp/blunt dissection
Mass noted adhered to plantar fascia (medial band)
Excised in toto (6cmx2cm)
Smaller fibromas noted in soft tissue (medial plantar fascia band)
Excision of medial plantar fascia band to prevent recurrence
15. Plantar Fibroma/Fibromatosis Procedure cont.
Closed with 3.0 vicryl/4.0 nylon
NWB with crutches for 3 weeks
16. Plantar Fibroma/Fibromatosis Pathology:
Benign plantar fibromatosis left foot