Surgical Excision of Plantar Fibromas
A fibroma is a benign fibrous tissue tumor or growth, that can occur anywhere in the body, for example in the uterus they’re called fibroids. On the plantar, or bottom surface of the foot, they are called plantar fibromas. Unlike plantar warts, which grow on the skin, these grow deep inside on a thick fibrous band called the plantar fascia. When non-surgical measures for treating plantar fibromas, such as orthotics have failed to provide adequate relief of symptoms, surgical removal is a reasonable option. Attempts may be made to surgically remove solitary nodules (a single lump or bump) with wide excision, however there is reported to be a high incidence of recurrence. Multiple plantar fibromas generally require more extensive excision of the entire fibrous band of plantar fascia (known as a Steindler plantar fascial stripping), inorder to insure complete removal and prevent recurrence.
Description of the Surgery
The surgical procedure involves a long, often curvilinear, incision on the bottom of the foot. The incision extends from the heel to the ball of the foot. The surgeon will dissect through the fatty tissue layer on the bottom of the foot to expose the thick fibrous plantar fascia. The plantar fascia, which includes the multiple benign fibromas, extends from the bottom of the heel, through the arch, all the way to the ball of the foot. The fascia removal requires careful separation from deeper soft tissues structures, and small nerves. Once the fascia has been removed, the bottom of the foot is stitched closed. Often a drain is placed into the surgery site to help prevent blood and other fluids from collecting here. The surgical wound is bandaged and the patient must remain non-weight bearing on the foot (with crutches) for a minimum of three weeks. Normal post-operative care including rest, ice, elevation, and maintaining a clean surgical site would be followed. The drain is usually removed 3 to 5 days after the surgery. The stitches are removed between 2 and 3 weeks after the surgery.
Post Operative Advice
Achilles tendonitis generally responds very well to conservative treatment as long as it is diagnosed and treated early. Surgery is rarely indicated unless the Achilles tendonitis is particularly severe and chronic, or if the tendon has ruptured completely.
Initially, the podiatrist may treat the Achilles tendonitis by putting heel lifts into the patient’s shoes. In addition, the patient may be asked to avoid barefoot walking or walking in low-heeled shoes. Non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (Motrin, Advil) and naproxen (Naprosyn, Aleve) may also be prescribed to calm the inflammatory process in the tendon. Icing may be suggested to help decrease the inflammation and pain in the tendon. Stretching exercises for the calf muscles may also be given to the patient to help loosen the calf muscle and Achilles tendon so that the tendon is not under as much stress during normal daily walking activities. The stretching should not be done however if it causes pain in the Achilles tendon.
Initially, the patient with Achilles tendonitis will be asked to modify their activities to decrease their running and jumping activities and do alternative physical activities, such as swimming, which don’t put as much stress on the Achilles tendon. As the tendon starts to feel better, the podiatrist will allow a gradual return to normal running and jumping activities. If normal return to activities is not possible within a few weeks, then many times the podiatrist may additionally prescribe physical therapy and/or functional foot orthotics to help the tendon heal more rapidly. The foot orthotics generally are used during both the sports activities and walking activities to allow for more normal foot and Achilles tendon function. If the physician is concerned about a partial tear of the tendon the patient may be placed in a below the knee cast. It can take several weeks or even months for the tendon to heal depending upon the severity of the injury to the tendon. It is not uncommon for a patient to return to activities too quickly and re-injure the tendon. Careful monitoring of a return to full activity is important and the patient must have patience during this period of time.
Some possible complications of the surgery include infection, swelling, and numbness on the bottom of the foot. The possibility of uncomfortable scarring on the bottom of the foot may also develop if the patient walks on the foot, damaging the incision, before the incision is properly healed. As previously mentioned, recurrence of the plantar fibroma is also possible, although this becomes less likely with removal of the entire plantar fascia. Other less common risks associated with this surgery should be personally reviewed with your own surgeon, as individual factors may play a role.