Are foot orthotics effective in the treatment of plantar fibromatosis?

FOOT ORTHOTICS AND PLANTAR FIBROMATOSIS – LEDDERHOSE DISEASE

Foot orthotics are an effective modality for the treatment of a broad range of foot pathology. The term “orthotic” is often used loosely to describe simple over the counter arch supports to complex prescription devices used to alter gait and posture and modify foot function.

Orthotics are often used to treat plantar fasciitis (inflammation of the plantar fascia) in which there is a mechanical or biomechanical cause. The plantar fascia is a broad band of fibrous tissue or ligament that starts at the bottom of the heel bone (calcaneus) and attaches to the bases of the toe joints. It acts as a strut which assists in the support of the joints of the foot and acts as a spring which enables one to push off when walking.

The plantar fascia is strong as it is designed to resist repetitive pulling caused as the foot lowers to the ground with each step, that is, it has high tensile strength. The fascia is not as resistant to twisting motion or torsional strain. Torsion of the fascia occurs with rolling motions of the foot – pronation or rolling in and supination or rolling out. Excessive pronation or excessive supination of the rearfoot results in torsion or twisting of the fascia and plantar fasciitis.

Foot orthotics created for the treatment of plantar fasciitis work in two manners. First, and most important, they are designed to relieve torsional stress on the fascia. Second, they provide some arch support as the act of raising the arch can releive tension on the plantar fascia.

Is plantar fibromatosis related to plantar fasciitis? The answer to that is not clear. There are patients with both plantar fasciitis and plantar fibromatosis (Ledderhose disease) but many who just experience the fibromas or nodules.

Do foot orthotics benefit those with plantar fibromatosis? Again, there are varying opinions on this.

I feel that if there is both plantar fasciitis and plantar fibromatosis and especially if patients exhibit biomechanical issues, then the answer is yes. The issue is that the nodules or fibromas prevent fitting and use of a properly constructed orthotic. A foot orthotic need follow the contours of the feet closely but the nodules distort the contours of the foot. Addtionally, the arch of the orthotic may place painful pressure on the fibromas.

Here are two practical means for patients with plantar fibromatosis to be able to utilize foot orthotics.

1. Reduce or eliminate the nodule size using methods discussed on this website, then, take impression casts to create the orthotics.

2. Create a groove or channel in the shell of the orthotic to accommodate the nodules. The groove can be eliminated when the nodules are gone. Larry Huppin, DPM of Prolab, a major prescription foot orthotic lab has a good description of the process: http://www.prolaborthotics.com/Default.aspx?tabid=90&EntryID=378

For more information on foot orthotics see: http://www.footorthotics.pro/