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.
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 ().