Definition
Fibrous proliferative lesion in plantar fascia
Epidemiology
Male, white, middle age
May arise in isolation
Association Dupuytren's Diathesis
- aka Lederhosen disease
Pathology
Proliferative Fibroblastic lesion
- May resemble fibrosarcoma histologically
Histology
Heavy strands of relatively acellular mature collagen
Enneking 3 Stages
- proliferative phase
- involutional (active) phase
- final (residual) phase
History
Present with lump in foot
Often painless
- unlike Dupuytren's there is no inflammatory proliferative phase
- asymptomatic through growth
Examination
Tender subcutaneous nodule found in the medial half of the middle plantar fascia
- rarely causes contracture
DDx
Ganglion cyst
Neurofibroma / neurilemmoma
Fibrosarcoma / any of the other sarcomas
Rheumatoid nodule
Melanoma
Sweat gland carcinoma
MRI
Useful
- T1 - low SI
- T2 - low or medium SI
Management
Non Operative
Observe if not symptomatic
Symptomatic
- padded shoes and orthoses
- transfer weight away
Operative
Indications
1. Relieve associated symptoms from local extension & invasion
- may invade NV structures
2. Pain when weight bearing
Problems
May recur after excision
- usually after incomplete / simple excision
- can recur & become locally invasive
- doesn't metastasise or become locally destructive
Technique Wide resection
Position
- prone
- tourniquet
Incision
- S shaped
- avoid 1st MT head
- avoid weight bearing arch
- minimise disruption of blood supply
- usual medial longitudinal incision interrupts most of the arterial supply to the skin beneath the longitudinal arch
Block resection of plantar fascia
- 2 cm normal fascia proximal and distal
- entire width
- lateral plantar nerve is adherent to fascia on lateral side
Recurrence
Consider radiotherapy