Having a worrying lump is bad enough for anyone to have to deal with.
Your immediate thoughts are to think the worst and start researching on Google for the symptoms – which is not a good thing to do!
If you have a worrying lump on the bottom of your foot, that you can feel painfully every time you walk or run, you might be thinking you have something seriously wrong.
However, cancer of the foot, especially within the muscles, tendons and fascia are quite a rare thing – so that will help put your mind at rest.
But wait! You still have that painful lump to deal with!
Luckily, it is most likely just a condition called Plantar Fascial Fibromatosis, or Plantar Fibroma.
What is Plantar Fibroma?
A plantar fibroma is a nodule (small lump) that grows under the skin on the bottom of your foot which causes pain when you walk. Multiple nodules are known as plantar fibromatosis.
A plantar fibroma is a fibrous knot (nodule) in the arch of the foot. It is embedded within the plantar fascia, a band of tissue that extends from the heel to the toes on the bottom of the foot. A plantar fibroma can develop in one or both feet, is benign (nonmalignant) and usually will not go away or get smaller without treatment.Source: Foot Health Facts by ACFAS
On the sole of your foot is a band of tissue that runs from the heel bone (calcaneus) to the ball of your foot. This is the fascia which helps to give your foot some rigidity, especially around the arch area.
If you damage your fascia, small lumps or “nodules” can develop along the surface, getting larger or thicker as they heal, become broken again and start to re-heal.
It can also be caused by genetics too, as well as being more common for people who suffer from Peyronie’s and Dupuytren’s disease. Getting Plantar Fibromatosis is also more common for people who are taking drugs classed as beta-blockers.
Common plantar fibroma symptoms:
- You can feel lumps or nodules under the skin of the sole of your foot.
- The lumps are rigid and do not move with the skin.
- They can be painful to the touch or pressure, depending on their location.
- You get pain when you walk or stand, especially in bare-feet.
Note: if you have a lump on your foot that appears to be on the top of the skin, rather than deeper in the tissues, it could be a Plantar Wart (Verruca Plantaris).
These are easily treated by either leaving them alone to disappear on their own, through to freezing them off or using to help them shrink.
It is also possible that there are many smaller growths around one area, which together form a larger lump. You can also notice that these lumps are fixed under your skin – they do not move around at all, which can also be worrying if you think you have found something bad.
One thing to remember is that these lumps grow very slowly and are not something that suddenly appear out of the blue. You may have only just started to notice them because they are painful to walk or stand with – but they are not something that will happen suddenly due to damage or exercise.
Why does a plantar fibroma hurt?
The main symptom people will experience Plantar Fibroma is a sharp pain when standing or walking. The nodules might also feel tender if you are pressing on or near them, or rubbing your feet with your hands.
It is also possible that you may have some swelling or inflammation around the sole too.
You may also be able to feel some that are there, but are not painful. It does depend on the location as to whether they will cause you pain and irritation. If the lump is nearer some more sensitive tissue or nerves around the fascia, this could be very painful and walking may become difficult.
The lumps themselves are not causing the pain – it is the additional pressure on the surrounding tissues, nerves and muscles that causes the pain.
How can I treat plantar fibromatosis?
Unfortunately, unless you want to opt for surgery, treatment of plantar fibroma is usually restricted to managing the condition.
Nodules from Plantar Fibroma will not go away on their own – they are here to stay, so making sure you start to manage to live with them and prevent them from getting worse is very important.
“Treatment of plantar fibromatosis is usually not worthwhile unless the bumps become large enough to cause pain when bearing weight. If so, orthoses (devices placed in the shoe) can help redistribute pressure away from the bumps.”Source: MSD Manuals
The most simple management will involve using physiotherapy or stretches to help keep the plantar fascia from being too tight (which may have been the cause of the issue in the first place).
There are also gel pads, support socks or inserts that can be used in your shoes to reduce pressure in that area.
These products are not 100% effective at removing the pain, but can go a long way to help reduce the intensity.
Another less invasive treatment is to have a corticosteroid injection into the lump and area which is used to try to shrink the size of the lump.
Unfortunately, this is only a temporary measure and after a while they will start to regrow, returning to their original size.
If these treatments have no effect, or the fibromas start to get worse, the only option left is to have them removed surgically. My feelings are that surgery should be avoided at all costs, but these nodules can become very painful and cause life-changing symptoms for the sufferer.
Surgery to remove them can be quite complicated too, depending on their size, location and age.
One good point to note is that smaller nodules are easier to remove and the fascia tissue will begin to heal itself after the surgery.
However, having larger ones removed can lead to parts of the plantar fascia being removed, which will require longer recovery and may possibly result in problems with stability in that foot.
It is even possible that the scar tissue from the removal of a large mass may cause more pain than the fibroma that was removed.
Of course there are ways to avoid this, by grafting tissue on the area where a gap was created, helping to repair the fascia.
Plantar Fibroma surgery recovery time.
Like most surgery, the recovery time can vary from person to person. After surgery to have the nodules removed, you will be fitted with a surgical drain to prevent any unwanted fluids accumulating in that area.
However, the drain is usually removed after around 3-5 days and the stitches later after a few weeks.
It is also important that you remain non-weight bearing on that foot for at least 3 weeks.
After around 1 month, you would be expected to follow up with physiotherapy to help keep the foot joints and ligaments mobile and stretched. After this, you could expect to start playing sports after around 3 months, despite some further tenderness.
How successful is plantar fibroma surgery?
One other thing to consider is that plantar fibromatosis, has a high risk of recurrence after surgery. An article on PubMed reports that the rate of these lumps returning can be as high as 60%
This can be due to the scar tissue created by the surgery or do to the underlying cause of the injury in the first place.
So it’s not a case of just having them removed once and then being set.
Finally – a friendly word…
I am not a trained doctor or podiatrist, so I would recommend that if you are reading this article and you have a painful lump on the sole of your foot, take comfort that it is highly likely that it is nothing more than Plantar Fibroma.
However, seeing a podiatrist as soon as possible is very important if you are to reduce the risk that surgery will be required but also catch any more serious problems early.
Your podiatrist or foot specialist will be able to advise on the best way to proceed after they have examined you.