Nearly a decade ago, a 58-year-old male presented for the evaluation of a painful soft tissue mass involving the left plantar foot. After conservative means were exhausted, he opted for surgery and elected to have a wide en bloc excisional removal of the mass. Pathology was consistent with PF. His post-operative period was uneventful and he remained asymptomatic for several years until November 2019. He presented again at this time for the evaluation of a gradually enlarging, symptomatic soft tissue mass in the same area as the original mass (Figure ). Upon examination and further history, it was felt that this mass was consistent with a recurrent plantar fibroma. His past medical history was particularly remarkable for Type II diabetes and morbid obesity. Other problems included high cholesterol, anxiety, and depression. Social history included controlled substance abuse. His physical exam was normal. Specific exam of the soft tissue mass revealed a firm, tender, nodular mass involving the left plantar medial arch in the same region of a well-healed, mildly hyperkeratotic surgical scar. Plain radiographs were negative. When he opted for surgery, the risks and benefits were outlined of both complete fasciectomy and wide en bloc resection. He chose the latter technique. An MRI was ordered that revealed changes consistent with a PF mass (Figures , ). Surgery was completed without complications. Wound management included placement of a battery-powered ciNPT device (Prevena™) and light compression bandaging. The device remained in place for one week and was then removed. No significant swelling or erythema was seen (Figure ). Surgical pathology was consistent with a solitary benign plantar fibromatosis lesion. Sutures remained in place for a total of three weeks. At this time, the incision was found to be negligibly tender, flat and well coapted. Partial weight bearing in a walking boot was initiated. At two weeks from the time of suture removal, he was transitioned to full weight bearing. At just over three months, he was discharged from care symptom free without signs of recurrence.
A 50-year-old male came to our department with walking difficulties because of painful bilateral plantar nodules. Visual inspection revealed solid nodules with 4 cm in diameter bilaterally in the medial plantar regions (). About 15 years ago, the asymptomatic nodules were simultaneously noticed being the size of a grain of rice, although the growing nodules caused difficulties and pain with footwear. Additionally, he also had Dupuytren’s contracture in his right palm (). Conversely, Doppler auscultation revealed arteriosus vascular sound on the mass in the bilateral plantar.\nA plain magnetic resonance imaging (MRI) scan revealed soft subcutaneous mass in the bilateral plantar with a dark signal on T1-weighted images, while a brighter signal than muscles on T2-weighted images (). In turn, MR angiography visualized symmetrical mass bilaterally as a high density area (). In contrast, MRI scan of his right palm showed a thick cord with a dark signal on both T1- and T2- weighted images (). To rule out the possibility of hemangioma, a biopsy was performed, resulting in the diagnosis that PF was strongly suspected.\nHe had neither family history of PF nor history of diabetes/epilepsy. He is a LGBT person and orchiectomy was performed 7 years ago. Instead of lost androgenic hormone, female hormone therapy had been prescribed with 1 mg of norgestrel and 0.1 mg of ethinyl estradiol per day.\nSince the patient wanted surgical treatment, operation under general anesthesia was performed (). Skin incision enabled the observation that the medial plantar neurovascular bundles were involved in the mass in the right foot. Therefore, it was necessary to dissect the medial plantar neurovascular bundles from the mass before excising the mass en bloc with a 1 cm safety margin. In contrast, there was no such finding in the left plantar. The primary wound closure was performed and suction drains were left. The patient was instructed to prevent the operation sites from bearing weight for 2 weeks. The skin wound healed uneventfully and he was released from the hospital 15 days after his operation. The final pathological diagnosis was PF. After 6 months, the patient is free of pain and is able to wear his shoes without any trouble ().