Understanding Plantar Fibromas (Ledderhose Disease): Symptoms, Treatments, and Solutions

Plantar Fibromas, also known as Ledderhose Disease, are benign nodules of fibrous tissue that develop on the bottom of the feet, and cause pain and difficulty walking.
(800) 871-8606
APPOINTMENT
Plantar Fibromas (Ledderhose Disease) Treatment

Understanding Plantar Fibromas (Ledderhose Disease): Symptoms, Treatments, and Solutions

  • 10 Main Street, San Francisco, CA 99999
  • (800) 871-8606
Appointment
(800) 871-8606

Office Hours

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Table of Contents

What Are Plantar Fibromas?

Plantar fibromas are firm, rubbery nodules that form within the plantar fascia—the thick band of connective tissue running along the bottom of your foot. These lumps are made mostly of collagen (scar tissue) and often feel like a pebble under the skin. Though they are not cancerous, their location makes them painful to walk on, especially when barefoot or in unsupportive footwear.

An in-office exam combined with diagnostic ultrasound is typically used to confirm the presence, size, and location of a fibroma.

What Is Ledderhose Disease (Plantar Fibromatosis)?

Plantar Fibromas, or Plantar Fibromatosis is also called Ledderhose disease, It is considered a genetic condition, often affecting both feet and sometimes occurring alongside Dupuytren’s contracture in the hands. The condition arises from microtears in the plantar fascia, which “over-heal” and lead to excessive collagen production/lumps of scar tissue.

This results in:

  • Single or multiple nodules on the arch of the foot
  • Tingling or nerve compression symptoms (like burning or numbness) if a fibroma presses on a nearby nerve
  • Progressive discomfort and pain with walking

Proven Treatment Options for Plantar Fibromas

While fibromas do not resolve on their own, there are multiple non-surgical and surgical options available to reduce their size, alleviate pain, and improve foot function.

Enzyme Injections + Shockwave Therapy

This innovative, non-surgical treatment is our first-line recommendation for most patients and is most effective when all steps are used concurrently:
  • Enzyme Injections (Hyaluronidase): Administered weekly for 3–5 sessions under ultrasound guidance to soften and shrink the fibroma.
  • Shockwave Therapy: Applied just before each injection to improve enzyme penetration and enhance results.
  • Topical Verapamil Gel: Applied twice daily for 6–12 months to further reduce collagen synthesis and promote fibroma shrinkage.
Dr. Steven Klein, one of our Bay Area Foot Care Podiatrists and our specialist for this condition/treatment, reports a 70% success rate with this protocol, ranging from complete resolution to pain-free walking due to size reduction.

Custom Foot Orthotics

Used as a complementary treatment to injections or after surgery:
  • Reduces tension on the plantar fascia
  • Designed with pressure-relief accommodations around the fibroma
  • Created using laser foot scans and biomechanical analysis
Our providers and staff will work with you to determine if insurance will cover your custom orthotics. If they are not covered, we will work with you to establish your options.

Minimally Invasive Surgery: Medial Band Release

This outpatient procedure does not remove the fibroma but instead releases tension in the plantar fascia to reduce stress and prevent recurrence. Often used in resistant cases or proactively in high-risk patients.

Surgical Excision with Collagen Matrix Grafting

Traditional surgical removal of the fibroma has been associated with a 45–85% recurrence rate, but newer methods are improving outcomes:

  • A collagen matrix is used to fill the gap left by the excised fibroma.
  • In select cases, a nerve decompression procedure is also performed to alleviate big toe symptoms caused by nerve impingement.

Surgical Excision with Mitomycin C

A breakthrough in fibroma management comes from applying Mitomycin C, an anti-fibrotic agent, to the surgical site after excision. According to a 2018 study published in The Journal of Orthopedic Research:

  • Patients who received Mitomycin C application post-surgically, had zero recurrence at follow-ups between 6 and 24 months.
  • The control group (no Mitomycin C) had a 58.6% recurrence rate.

Mitomycin C works by inhibiting fibroblast activity, which is responsible for excessive collagen production. Topical use is safe, though mild local irritation may occur.

Risks of Surgery

As with any surgical intervention, the following risks must be considered:

  • Infection
  • Poor wound healing
  • Excessive pain
  • Nerve damage
  • High recurrence (if not using collagen matrix or Mitomycin C)
  • Development of new fibromas in other areas

Radiation Therapy

In collaboration with experienced radiation oncologists, focused radiation is used to stop fibroma progression:

  • Ideal during the proliferative stage (early and actively growing fibromas)
  • Protocol involves daily treatment for 5 days, repeated after 6–8 weeks
  • Most effective in the first 6–12 months of fibroma development

Important Note: Surgery on a previously irradiated area is generally avoided due to healing complications.

Recommended Treatment Pathway

For most patients, we recommend the following progression:

  1. Start with enzyme injections + shockwave + Verapamil + orthotics
  2. Reserve surgery (with collagen matrix or Mitomycin C) for select cases
  3. Consider Radiation if the previous treatment options have already been tried and failed.

Conclusion

Plantar fibromas may be benign, but they are far from harmless. Left untreated, they can significantly impair mobility and quality of life. With proper evaluation and modern treatment protocols like enzyme injections, shockwave therapy, and surgical or radiation options, there is real hope for lasting relief. If you suspect you have a plantar fibroma or have been diagnosed with Ledderhose disease, schedule a consultation with Dr. Steven Klein at Bay Area Foot Care. Early intervention can help you avoid surgery and preserve your comfort and mobility.

FAQs

Plantar fibromas often arise from micro-injuries to the plantar fascia that “over-heal,” forming excessive scar tissue. Genetics also play a role, and they are often associated with conditions like Dupuytren’s contracture.
Yes. Ledderhose disease is another name for plantar fibromatosis, a condition marked by collagen nodules in the arch of the foot. The terms are used interchangeably.
No. These fibromas do not resolve spontaneously. However, many non-surgical treatments can reduce their size and symptoms, especially when caught early.
Steven N. Klein, DPM

Dr. Steven Klein

Dr. Steven Klein is a leading podiatric expert specializing in the diagnosis and treatment of Plantar Fibromas and Ledderhose disease (also known as Plantar Fibromatosis). With decades of experience and a commitment to minimally invasive care, Dr. Klein has pioneered effective non-surgical protocols, and also offers advanced surgical options when needed. Patients from across the region trust Dr. Klein for personalized, evidence-based care and outstanding outcomes in treating fibromas of the foot