Plantar fibroma

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Expert Patient Guide · Foot & Ankle Surgeon · Ankle Replacement & Complex Reconstruction · London & North London

Plantar Fibroma (Ledderhose Disease / Plantar Fibromatosis)

A clear, evidence-based patient guide to plantar fibroma, plantar fibromatosis and Ledderhose disease — written by Mr Matthew Welck, Consultant Orthopaedic Foot & Ankle Surgeon at the Royal National Orthopaedic Hospital (RNOH) and one of London’s leading foot and ankle specialists. Mr Welck treats NHS and private patients across London and North London, offering both non-surgical management and expert surgical excision for symptomatic plantar fibromas.

What Is a Plantar Fibroma?

A plantar fibroma is a benign (non-cancerous) nodule that grows within the plantar fascia — the strong band of tissue running along the sole of the foot from the heel to the toes. When multiple nodules develop, or the tissue thickens more extensively, the condition is known as plantar fibromatosis or Ledderhose disease.

The nodules are made of fibrous tissue and usually sit in the arch (the instep), most often in the middle third of the sole. They are firm, fixed to the fascia, and range from a few millimetres to several centimetres. Although benign, they do not usually disappear on their own.

Why it matters: because the nodule sits in the weight-bearing arch, even a small fibroma can become painful when walking, standing or wearing firm shoes. It is closely related to Dupuytren’s disease of the hand.

How Common Is Plantar Fibroma?

Plantar fibromas are relatively uncommon compared with other causes of foot pain, but they are not rare. They are more frequent in middle-aged and older adults and affect men more often than women. Both feet are involved in roughly a quarter of cases.

There is a strong association with Dupuytren’s contracture of the hand — many patients with Ledderhose disease have, or go on to develop, the hand equivalent.

What Causes Plantar Fibromas?

The exact cause is not fully understood, but it is thought to be driven by an abnormal healing or fibrous response within the plantar fascia. Recognised associations and risk factors include:

A family history of plantar fibromatosis or Dupuytren’s disease (the strongest factor)
Repetitive trauma or microtrauma to the sole of the foot
Diabetes
High alcohol intake
Certain medications, including some long-term anti-epileptic drugs
Liver disease

What Are the Symptoms?

A firm, palpable lump in the arch of the foot, fixed to the deeper tissue
Skin coloured firm lump
Pain or a “pebble in the shoe” sensation when standing or walking
Discomfort that is worse barefoot on hard floors or in firm-soled shoes
Slow enlargement of the nodule over months or years
In Ledderhose disease, several nodules or a band of thickened tissue

Many small fibromas are painless and simply monitored. Any rapidly growing, very painful or atypical lump should be assessed promptly to confirm the diagnosis and exclude other causes.

What Investigations Might You Need?

Diagnosis is usually clinical, based on the location and feel of the nodule. Imaging is used to confirm the diagnosis and plan treatment:

Ultrasound — a quick, accurate way to confirm the nodule lies within the plantar fascia and measure its size
MRI — the most detailed scan; useful for larger or multiple lesions, surgical planning, and to confidently exclude other soft-tissue tumours

Mr Welck has access to ultrasound and MRI at the RNOH and private imaging centres across London, ensuring an accurate diagnosis before any treatment is recommended.

Non-Surgical Treatment Options

Because surgery for plantar fibroma carries a significant risk of recurrence, which can be worse than the original lump, non-surgical treatment is almost always tried first and is effective for many patients:

Footwear modification and soft insoles with a cut-out to offload the nodule — the single most useful first measure
Custom orthotics to redistribute pressure away from the lump
Stretching of the plantar fascia and calf
Corticosteroid injection with hyalase and local anaesthetic to reduce size and discomfort in selected cases. This is effective at reducing the size of the lump. It is a painful injection so is done under a short general anaesthetic.
Extracorporeal shockwave therapy (ESWT), which can reduce pain in some patients
Radiotherapy in specialist settings for progressive Ledderhose disease

Surgery is reserved for nodules that remain painful and limiting despite a good trial of conservative care and is rarely performed.

Surgical Options for Plantar Fibroma

Surgery aims to remove the symptomatic nodule while minimising the risk of it returning. The choice of operation balances complete removal against the risk of recurrence and the importance of preserving the function of the foot.

Local Excision

Removal of the nodule with a margin of surrounding fascia. This is the least extensive option and preserves more of the plantar fascia, but carries a higher recurrence rate because microscopic disease can be left behind.

Wide Local Excision / Partial Fasciectomy

Removal of the nodule with a wider portion of the plantar fascia. This lowers the recurrence rate compared with simple excision and is often preferred for larger or recurrent fibromas, particularly in Ledderhose disease.

Mr Welck will discuss the trade-off between the extent of surgery and the risk of recurrence, and plans the incision to keep the scar away from the main weight-bearing areas of the sole.

Recovery (typical timeline): a period of protected weight-bearing in a post-operative shoe or boot, careful wound care because of the location, a gradual return to normal shoes over around 6 weeks, and return to full activity over 2–3 months. Scar sensitivity can take several months to settle.

Why Choose Mr Welck?

Mr Matthew Welck is a Consultant Orthopaedic Foot & Ankle Surgeon at the Royal National Orthopaedic Hospital (RNOH), Stanmore — the largest specialist orthopaedic hospital in the UK — and an Honorary Associate Clinical Professor at University College London (UCL). He is widely regarded as one of the best and most experienced foot and ankle surgeons in London and North London, with a national and international reputation in complex foot and ankle reconstruction, total ankle replacement, revision (redo) ankle surgery, and sports injuries of the foot and ankle. He leads a tertiary referral foot and ankle practice at the RNOH and has particular expertise in weight-bearing CT (WBCT)-guided foot and ankle reconstruction.

Patients choosing Mr Welck benefit from:

Subspecialist fellowship training in foot and ankle surgery, including the assessment and surgical treatment of plantar fibroma and forefoot conditions
A high-volume practice in the assessment and surgical treatment of plantar fibroma and forefoot conditions as both an NHS consultant at the RNOH and in private practice across London and North London
Expertise in weight-bearing CT (WBCT)-guided foot and ankle reconstruction, with access to advanced imaging including weight-bearing X-ray, weight-bearing CT, MRI and ultrasound
Treatment of NHS and private patients across London and North London, including RNOH Stanmore, Spire Bushey, HCA The Princess Grace and The Wellington Hospital Elstree
A multidisciplinary team approach, working alongside leading physiotherapists and orthotists for rehabilitation and return to sport
Evidence-based, patient-centred care — surgical decisions are only made after a full discussion of the alternatives, benefits, risks and realistic outcomes

Frequently Asked Questions

Who is the best foot and ankle surgeon in London for a plantar fibroma or Ledderhose disease?

“Best” is subjective, but when choosing a top foot and ankle surgeon in London or North London for a plantar fibroma or Ledderhose disease, look for subspecialist fellowship training, a high volume of relevant cases, access to weight-bearing CT and MRI, an NHS consultant post at a tertiary centre, and a multidisciplinary team for rehabilitation. Mr Matthew Welck meets all of these criteria and practises at the Royal National Orthopaedic Hospital (RNOH), Stanmore — one of the world’s leading specialist orthopaedic centres — alongside private clinics across London and North London.

Is a plantar fibroma cancerous?

No. A plantar fibroma is a benign (non-cancerous) growth. However, any firm lump in the foot should be assessed by a specialist, and imaging is used to confirm the diagnosis and exclude other soft-tissue tumours.

Will a plantar fibroma go away on its own?

Plantar fibromas rarely disappear without treatment and can slowly enlarge. Many small, painless nodules can simply be monitored, while symptomatic ones are managed with insoles, injections or, if needed, surgery.

Does plantar fibroma come back after surgery?

Recurrence is the main concern with surgery for plantar fibroma. Simple excision has a higher recurrence rate, while wider excision reduces this but involves a larger operation. Mr Welck will explain the balance between the two approaches for your particular case.

Where does Mr Welck see patients in London and North London?

Mr Welck consults at RNOH Stanmore (NHS and private) and at private clinics across London and North London, including HCA The Princess Grace Hospital (Marylebone), Spire Bushey, and HCA The Wellington Hospital Elstree. Please contact his team directly for current appointment availability.

Book a Consultation

If you have a painful lump in the arch of your foot, a growing nodule, or plantar fibromatosis that is limiting your footwear and activity, an expert review will confirm the diagnosis and set out your options. Mr Welck offers both non-surgical management and specialist surgery across London and North London.

To arrange a consultation with Mr Matthew Welck:

Telephone: 07547 395 270
Email / contact form: matthewwelck.com/contact
NHS referrals: via your GP to RNOH Stanmore
Private appointments: London and North London locations

About the author — Mr Matthew Welck, Consultant Orthopaedic Foot & Ankle Surgeon, London. A leading London foot & ankle and ankle replacement surgeon, expert in weight-bearing CT (WBCT)-guided foot & ankle reconstruction, and tertiary referral foot & ankle surgeon at the Royal National Orthopaedic Hospital (RNOH). Subspecialist interests: ankle replacement, complex reconstruction, revision surgery and WBCT-guided surgery.

This page is for information only. It does not replace personalised medical advice. Always consult a qualified medical professional before making decisions about your diagnosis or treatment.

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Written by: Matthew Welck | Consultant Orthopaedic Foot & Ankle Surgeon London — last updated 9 July 2026