A 62-year-old female presented for the evaluation of a symptomatic soft tissue mass involving the right plantar medial arch. Her symptomatology was relatively insidious by history and what prompted her visit was gradual intolerance of a certain shoe gear. She reported the mass was present for over a year but symptomology escalated about four months prior to initial evaluation. Her past medical history included hypertension, thyroid disease, Factor V Leiden pathology with a history of deep vein thrombosis, degenerative joint disease, and morbid obesity. Social history was unremarkable. Her physical exam was largely unremarkable except for significant pes planovalgus changes in both feet and a painful mass involving the right foot. Specific examination of the soft tissue mass revealed a mildly firm, slightly mobile, tender soft tissue mass in the medial plantar arch. Plain films demonstrated no acute process. Both non-operative and operative treatment options were offered and the patient chose the latter, electing for wide en bloc excision instead of complete fasciectomy. Prior to surgery, an MRI was ordered that demonstrated changes consistent with a solitary plantar fibroma lesion (Figures , ). Her surgery was without compromise and included perioperative anticoagulation bridge management in light of her history of deep vein thrombosis. Wound management included placement of a battery-powered ciNPT device (Prevena™) and light compression bandaging. At bandage takedown, the incison was observed to be well coapted with no complications (Figure ). The device remained in place for one week and was then removed. No drainage strikethrough was seen (Figure ). Surgical pathology was consistent with a solitary benign plantar fibromatosis lesion. Sutures remained in place for a total of three weeks. A walking boot was used for two weeks after suture removal. Healing progressed uneventfully with gradual increase in weight bearing and activities. Dorsal foot swelling on the operative foot persisted but eventually resolved. She ultimately returned to normal shoe gear at three months and was discharged from care without symptoms or signs of recurrence at six months.
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.