Orthopedics

ANSWER PLEASE

Brad R Bruns, MD; John Hunter, MD; David A Yngve, MD

Abstract

1. Pickren JW. Smith AG. Stevenson TW. et al: Fibromatosis of the plantar fascia. Cancer [951; 4:846.856.

1. Pedersen HE. Day AJ: Dupuytren's disease of the foot. JAMA 1954: 154:33-35.

3. Allen RA, Woolner LB, Ohormley RK: Soft-tissue tumors of the sole. J Bone Joint Surg (AM) 1955; 37:14-26.

4. Curtin JW: Fibromatosis of the plantar fascia. J Bone Joint Surg IAM) 1965; 47:1605-1608.

5. Stoylc TF: Dupuytren's contracture in the foot. J Bone Joint Surg (BR) 1964; 46:218-219.

6. Enneking WF: Musculoskeletal Tumor Surgery. New York. Churchill Livingstone Inc.. 1983.

Section Editor: William A. Grana, MD…

Fig. 1: Photograph of patient's feet at presentation.

Fig. 1: Photograph of patient's feet at presentation.

A 60-year-old white female presents with a 16-year history of painful lumps on the soles of both feet. She reports that she had surgery on her right foot several years prior, but the lumps recurred. She also states that several family members have a similar problem. She denies fever, chills, weight loss, or specific injury to her feet.

Examination shows several large, minimally tender nodules along the medial insteps of both feet (Figure 1). Examination of her hands show early Dupuytren 's contractures of the ulnar palmar fascia. Radiographs show corresponding soft tissue masses without bony involvement. The most likely diagnosis is:

* Lipomas

* Synoviomas

* Hypertrophy of ruptured tibialis posterior tendons

* Plantar fibromatosis

* Fibrosarcomas

Plantar Fibromatosis

Plantar fibromatosis, a benign condition, is also known as Dupuytren's disease of the foot, from Baron Dupuytren's record of its presence in his classic paper of 1839. ' These patients commonly present in the mid-decades of life with a 10-year or more history of slowly enlarging painless masses in the medial aspect of the longitudinal arch of their feet. Bilateral foot involvement is common, though contractures are rare, as opposed to Dupuytren's disease of the hand. This is due to the rare extension of the thicker, narrower, and longer plantar fascia to the phalanges of the foot.2

Traumatic, inflammatory, neurologic, degenerative, and familial etiologic factors have been implicated, though the exact etiology remains unknown. However, the condition is commonly associated with Dupuytren's disease of the hand, Peyronie's disease, and keloidal tendency.3

Histologically, the lesion characteristically consists of heavy bands of fibroblasts with rare mitoses, infiltrating the surrounding normal tissues. Seldom are the deeper tendons or muscles of the foot involved3 (Fig. 2, 3). Surgical excision is the mainstay of treatment, though recurrence remains the most common complication due to incomplete fascial excision.2,4,5 Radiation therapy has not been shown to be of any benefit.6

Fig. 2: Medium power photomicrograph showing proliferating fibroblasts adjacent to normal fascia.

Fig. 2: Medium power photomicrograph showing proliferating fibroblasts adjacent to normal fascia.

Fig. 3: High power photomicrograph demonstrating the uniformity and density of the proliferating fibroblasts.

Fig. 3: High power photomicrograph demonstrating the uniformity and density of the proliferating fibroblasts.

References

1. Pickren JW. Smith AG. Stevenson TW. et al: Fibromatosis of the plantar fascia. Cancer [951; 4:846.856.

1. Pedersen HE. Day AJ: Dupuytren's disease of the foot. JAMA 1954: 154:33-35.

3. Allen RA, Woolner LB, Ohormley RK: Soft-tissue tumors of the sole. J Bone Joint Surg (AM) 1955; 37:14-26.

4. Curtin JW: Fibromatosis of the plantar fascia. J Bone Joint Surg IAM) 1965; 47:1605-1608.

5. Stoylc TF: Dupuytren's contracture in the foot. J Bone Joint Surg (BR) 1964; 46:218-219.

6. Enneking WF: Musculoskeletal Tumor Surgery. New York. Churchill Livingstone Inc.. 1983.

Section Editor: William A. Grana, MD

10.3928/0147-7447-19860501-21

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