Plantar fibromatosis, also known as Ledderhose disease, refers to a benign fibrous proliferation that occurs in the plantar aponeurosis in the form of single or multiple nodules on the medial plantar surface of the foot.
The aetiology of the condition remains uncertain but is known to include trauma to the aponeurosis and systemic conditions such as diabetes mellitus, hypothyroidism, alcoholism, epilepsy and liver cirrhosis.
As described by Miceli et al., “the histopathological examination of plantar fibromatosis reveals dense fibrocellular tissue with parallel and nodular arrays of fibrocytes and fibrillar collagen with a distinctive cock-screw morphology, evidence of myofibroblastic differentiation”.
The slow-growing nodes in the medial portion of the plantar fascia can lead to shrinkage and sclerosis of the entire plantar fascia; this results in pain during weightbearing activities causing the patient difficulty in walking or standing.
According to Omor et al., MRI plays an important role in guiding clinical management of plantar fibromatosis because of a clear presentation of the degree of deep extension found in advanced, aggressive forms of plantar fibromatosis on MR imaging.
Early detection of the condition helps in the implementation of conservative treatment options which could include a combination of stretching exercises, orthotic management, non-steroidal anti-inflammatory drugs, padding and physical therapy.
The inclusion of MASS4D® customised foot orthotics in treatment strategies will help to provide the patient with relief from pain during ambulation by minimising tension on the plantar fascia and consequently, decreasing direct pressure on the plantar fibromas.
By supporting the foot in its optimal posture, MASS4D® promotes stabilisation of the medial longitudinal arch which enforces normal functioning of the plantar fascia; this prevents the ligament from stretching beyond its capacity and facilitates healing of the injured ligament.
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Repetitive plantarflexion can lead to pain and mechanical limitation in the posterior ankle joint which is known as posterior ankle impingement syndrome. This pathology commonly occurs in ballet dancers and football players.