A 44-year-old man with no significant medical history presented with an 8-year history of painless plantar nodule of the right foot. In the previous 6 months the patient felt discomfort while walking. On examination, he had subcutaneous nodules on the medial aspect of the plantar surface of the right foot. There was no family history of similar nodules. The patient was not taking any medication and was otherwise healthy. Vital signs and laboratory tests were normal.\nAn ultrasound () of the plantar arch was made using 13–5 MHz array transducer and showed a hypoechoic and homogeneous nodule of the plantar fascia with increased color Doppler flow. MRI of the foot confirmed the ultrasound data, showing a hyperintense nodule on proton density images () which was hypointense on T1-weighted images (), at the distal part of the superficial medial plantar fascia. The lesion was intensely enhanced after injection of Gadolinium ().\nThe diagnosis of Ledderhose disease was suspected based on the clinical-radiographic data. However, because of the flow inside the lesion at color Doppler, a biopsy was performed to rule out malignancies. Histological examination () of the nodule demonstrated increased fibroblastic activity and a reduction of the collagen network. Our patient received conservative treatment with anti-inflammatory drugs, physiotherapy, and orthotic support with satisfactory evolution.
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.