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plantar fibromatosis

Posted by Andy H on 8/24/03 at 21:05 (127874)

I just had surgery on the bottom of my left foot to remove a painful growth inside the foot. It felt like a bump in one place but stretched about four inches along the bottom of my foot. Initially I was told I had a Dupuytren contracture of the foot since I had hand surgery for this 2 years ago. However I now see it might be called plantar fibromatosis.

My plastic surgeon said he removed the Dupuytren's cord from the left foot but i now have a swollen area in the middle of my foot. I had the surgery on August 7. When the stitches were taken out on August 19 i discussed this swelling in the middle of my foot and the surgeon said that it was muscle that had moved into the area and that there was nothing he could do but I should walk on it. So far walking has been difficult due to the pain of the scar itself but I am wondering about the longer term.

Any comments?

Andy H

Re: plantar fibromatosis

Ed Davis,DPM on 8/25/03 at 09:46 (127899)

Andy:

At this point you simply need to wait for recovery. Phsical therapy modalities such as ultrasound and deep tissue massage will help.

I am sure your plastic surgeon has excellent technique but, if unfamiliar with this area, may not realize that such lesions have a 70% recurrence rate in the foot and as such, we generally treat them conservatively with great success. Get some good physical therapy, keep your fingers crossed that you are in the 30% that gets no recurrence but if they do come back, see a foot specialist.
Ed

Re: plantar fibromatosis

Barbara F. on 8/25/03 at 13:45 (127922)

I had surgery for fibromatosis of my right foot on April 8, 2003. It healed well, still have some pinching feeling when walking too much. I was told there was a 30% chance of recurrence .Basically doing OK. Barb

Re: plantar fibromatosis

Andy H on 8/25/03 at 18:52 (127962)

Thank you Ed Davis for your suggestions.

Do you think that this physical therapy would push the protruding muscles that are in the center of the scar back into the foot from where they came or should i just walk on it and let it push back in that way?

Andy H

Re: plantar fibromatosis

Ed Davis,DPM on 8/25/03 at 19:04 (127965)

Andy:

Are you sure that there are muscles protruding as opposed to swelling?
Have you discussed that with your surgeon?
Ed

Re: plantar fibromatosis

Andy H on 8/25/03 at 20:17 (127976)

It was the surgeon that told me that the swelling was muscles pushing out. It is now August 25 and I had the surgery on August 7. The area where the muscles are pushing out is football shaped ... approximately 2' long x 1' wide and somewhat centralized along the incision. The 2' dimension runs along the length of the incision. It is also quite noticeable when flexing my toes inwards ... I can feel the lump as though it is restricting movement. By the way the incision is approx 4' long.

Regards

Andy

Re: plantar fibromatosis

Ed Davis,DPM on 8/25/03 at 21:06 (127990)

Andy:

It is possible that if pressure is maintained on the area, that scar tissue will form to contain the area of protrusion.

There are two general means of excision of plantar fibromatosis. Simple excision involves removing the lesions with little adjoining tissue. That is less traumatic but has an approx. 70% recurrence rate. 'Radical' excision involves surgical removal of the lesions with a wide margin of the surrounding fascia. That is somewhat more diabling but lowers the recurrence rate to about 30%. Since radical excision leaves a larger tissue gap, I generally would sew a mesh (eg. vicryl mesh) which is a fabric to close the gap and prevent protrusion of the muscular layer.
I have done relatively few such procedures because it is so rare that conservative treatment fails for this.
Ed

Re: plantar fibromatosis

Andy H on 8/25/03 at 21:32 (127993)

Thanks Ed

I will discuss this with my plastic surgeoon but the fabric idea may be a bit too late. In the meantime, I am getting in my home spa and while sitting in one seat am pressing my left foot against the curved surface of the seat in front of me. Then I am slowly pushing the muscle bulge back in by moving my foot over the curved surface in 4 different directions. I cant think of anything that could be better than this.

I have done this for 2 nights in a row for approximately 15 minutes in the hot water and not exactly sure if this is working or not since the area is still tender and bulging.

I am planning to try this every night for a while to see if i can push the muscle bulge back to wherever it came from. What u think of this novel idea?

Regards

Andy

Re: plantar fibromatosis

Ed Davis,DPM on 8/25/03 at 21:39 (127994)

Andy:
That is something you could try but constant pressure is more likely to be successful. Scar tissue needs time to bridge over the muscle and hopefully fill the gap. Placing a soft pad and elastic wrap over the area is one means.

It is too late to discuss surgical technique with your surgeon although it may be helpful for his next case.
Ed

Re: plantar fibromatosis

Andy H on 8/25/03 at 21:46 (127997)

Thanks Ed

I will be his next case! I have to get my right foot done on Nov 14. This will be my third surgery for Duputren's. I had the ring finger on my left hand done 2 years ago (nice long scar) and now I notice that it is starting up in my adjacent little finger ... looks like yet another surgery. I have read that the progression in my left hand follows this sequence ... ring finger, little finger, middle finger and then index finger ... YIKES!

I think there are are lot of surgeries in my future unless you know of some miracle to avoid this hideous disease.

Thanks again Ed

Andy H

Re: plantar fibromatosis

Ed Davis,DPM on 8/25/03 at 23:06 (128009)

Andy:

What non-surgical treatments have you tried? I cannot speak for the hand but when it comes to plantar fibromatosis in the foot, most lesions can be alleviated by injecting them with a solution containing hyaluronidase and triamcinolone acetonide.
Ed

Re: plantar fibromatosis

Andy H on 8/26/03 at 02:35 (128015)

Hi Ed

I have not tried anything other than getting orthotics for each shoe, since the Dupuytren's cord is manifesting differently in each foot amd the orthotics had to be different. The left foot was worse so that is why surgery was done there first. Then the right foot surgery is planned for November. I am not aware or any other treatment to make the cord go away. Once the orthotics were in I was able to walk with less pain., however, it was still difficult ... in fact my surgeon wondered out loud how I was able to walk at all! Maybe I should be seeing a different doctor for injections?

Regards
Andy

Re: plantar fibromatosis

Ed Davis,DPM on 8/26/03 at 13:56 (128055)

Andy:

You are using the term 'Dupuytrens' to mean plantar fibromatosis?
If all you are being offered is surgery, I would definitely get a second opinion.
Ed

Re: plantar fibromatosis

Andy H on 8/26/03 at 17:39 (128086)

The surgeon referred to the thing he removed from my left foot as a Dupuytren's cord. However, I read on the internet that if it is in the foot then it is called plantar fibromatosis. If it is in the hand then it is called palmar fibromatosis. This is the web site where I read this ...

http://www.drgreene.com/21_173.html

Is it not the same thing?

I am going to see a foot specialist for the second opinion on my right foot.

Thanks again

Andy H

Re: plantar fibromatosis

Ed Davis,DPM on 8/26/03 at 18:22 (128090)

Andy:
The term 'Dupuytren's contracture' is generally not used in the foot. The entities in the palm and sole are similar but not exactly the same. We don't generally see the same degree of contracture of the tissues in the sole as one can see in the hand. Perhaps becausing walking on the foot keeps the tissues stretched out more. Best wishes..
Ed