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 56-year-old female presented for the evaluation of gradual onset bilateral soft tissue masses involving the plantar surface of both feet, with the left foot being significantly more symptomatic. Her past medical history included hypertension and high cholesterol. Social history included gainful employment in a moderately labor-intensive type job and several-year history of smoking. Her physical exam was essentially normal with the exception of somewhat firm, slightly mobile nodular masses involving both plantar foot surfaces in the region of the plantar medical arch (Figure ). Tenderness was only noted involving the two masses on the left foot. Plain radiographs were negative. Conservative therapies were discussed and tried that included shoe gear and activity modification as well as analgesics. The patient declined injection therapy. An MRI was ordered that revealed two discrete soft tissue masses within the plantar fascia consistent with PF lesions without neurovascular encroachment (Figures , ). Surgery was proposed and she wished to proceed with surgery on her symptomatic left foot (Figure ). Risks and benefits were outlined for both complete fasciectomy and wide en bloc resection. The patient chose the latter technique and was advised to refrain from smoking that she did for several days both pre- and post-operatively. Surgery was completed without complications. Wound management included placement of a battery-powered ciNPT device (Prevena™) and light compression bandaging (Figure ). The device remained in place for one week and then was removed. No significant erythema or swelling was seen. Surgical pathology was consistent with two, benign PF lesions. Sutures remained in place for a total of three weeks and were then removed. At this time, the incision was found to be negligibly tender, flat and well coapted. She was non-weight bearing immediately post-operatively through suture removal at which time she was transitioned to a walking boot with instructions to gradually increase weight-bearing activities to tolerance. Rechecks were unremarkable with the exception of a small area of dehiscence that was seen one week after suture removal. Complete incisional healing was appreciated about a week after suture removal. She returned to normal, daily activities including unrestricted work just over two months with no symptomatology or recurrence at the one-year mark.