AOFAS 1999 ANNUAL SUMMER MEETING
Surgical Treatment of Painful Plantar Fibromatosis
G. James Sammarco, M.D.; Peter G. Mangone, M.D.; (Cincinnati, OH)

Hypotheses/Purpose: To determine if subtotal plantar fasciectomy is an effective treatment for symptomatic primary and recurrent plantar fibromatosis.

Conclusions/Significance: Subtotal plantar fasciectomy is a successful treatment for plantar fibromatosis with a low recurrence rate and high patient satisfaction but carries significant risks.

Summary of Methods/Results: A retrospective review was conducted of patients with plantar fibromatosis failing nonoperative treatment and requiring surgical excision between September 1991 and June 1998. Eighteen patients (23 feet) underwent subtotal plantar fasciectomy to remove the tumor with wide disease-free margins. Three patients (three feet) with less than 12 months follow-up were excluded from the study. Fifteen patients (20 feet) were interviewed using the subjective component of the AOFAS midfoot scale. Each patient was also asked questions concerning their satisfaction level and would he/she have the procedure done again.

There were six males and nine females with an average age of 50 years (range 11-67) at the time of diagnosis. Eleven of the 15 patients (73%) had bilateral plantar fibromatosis, and five patients (33%) also had Dupuytren's contracture. Twelve patients (17 feet) had excision of primary tumors, and three patients (three feet) had excision of recurrent tumors. Surgery was performed through a longitudinal plantar incision under loupe magnification. Average follow-up was 36 months (range 12-88). The average time to healing was two months. Delayed wound healing occurred in seven feet. Three feet required a split thickness skin graft. Two patients required further surgery: one with a recurrent tumor and one with an incisional neuroma.

The average subjective AOFAS midfoot score was 60 of a maximum score of 75 (range 16-75). Of the 20 operated feet, 70% (14/20) resulted in complete satisfaction, 15% (3/20) were satisfied with reservations, and 15% (3/20) were dissatisfied. Patients reported in 85% (17/20) of the cases they would have the procedure done again. Three patients, 15%, stated they would not have the procedure done again. One patient had plantar numbness without pain, one reported more pain than before surgery, and one reported clawing of the lesser toes with cramping pain.

Subtotal plantar fasciectomy is an effective treatment for painful primary and recurrent plantar fibromatosis. The need for wide resection combined with the tenuous blood supply to the skin delays incision healing. Because the tumor is aggressive and invades surrounding tissues, meticulous surgical technique under loupe magnification is necessary to minimize complications and recurrence.