Hi All,

My podiatrist just gave me an article from Podiatry Today. It gives a synopsis of current research and current treatment of LD (plantar fibromas) and even talks alittle about Dupuytren's, via a pro-surgery vs con-surgery approach. I highly recommend people take a look at it from the perspective of practicing Podiatrists. It is easy to access on-line, go to www.podiatrytoday.com, go to Archives, then pick the February 2013 issue, the name of the article is Point-Counterpoint is Conservative Care the Best Approach for Plantar Fibromatosis?

Some interesting points are the very high rate of recurrence of Fibromas with surgery, some success with repeated steroid injections, and most interesting was a reference to a recent small study of the use of Xiaflex for the treatment Fibromas-which they call "potentially positive".

Hope this helps for people trying to decide what to do with our frustrating condition.

Fjellver

Thank you, fjellver, for posting that article. It is good to see a debate re. whether surgery is good, and what kind of surgery is good, for large nodules.

The first author, Downey, says he is performing this injection treatment:

I currently use triamcinolone acetonide for the intralesional injection of plantar fibromas. A series of three to five injections with each injection spaced three to six weeks apart appears to be most effective. While the optimal dosage for each injection has yet to be determined, I currently use 15 mg to 30 mg per nodule and this appears to be a reasonable initial dose based upon the literature available. As Pentland and Anderson found, the nodules consistently soften and shrink (although they seldom resolve entirely), and the symptomatology resolves.

He doesn't say what size of nodules he treats.

The second author, Huthchinson, claims that conservative methods like the injection don't work if the nodule is 1 cm thick:

It is my opinion that early on when there is a small isolated nodule, conservative care can be effective but once there is a coalescence of these nodules or they become bigger than 1 cm in depth, conservative management is ineffective and frankly is rarely even palliative. When patients cannot walk because of the pain, the only option becomes surgical intervention for a consistent, predictable outcome. This is also true for those individuals who have a family history of the disease or other conditions such as Peyronie’s disease. These patients tend to do extremely poor with conservative care in particular and can have a higher recurrence with surgical intervention unless they receive a total fasciectomy.

Neither author is presenting any data from a clinical trial. But it seems like an informative useful discussion, anyway.