Plantar fibroma (Ledderhose disease): a lump in the arch, when to get it checked, and what helps

What a plantar fibroma is

A plantar fibroma is a firm lump of fibrous tissue within the plantar fascia, the band of tissue that runs under the sole from the heel bone to the base of the toes. It usually sits in the arch. There can be one lump or several, in one foot or both, and an NHS podiatry leaflet describes it as usually benign (not cancer), "with a very low incidence of malignancy".

Several lumps are often called plantar fibromatosis or Ledderhose disease. It belongs to the same family as Dupuytren's contracture in the palm of the hand and Peyronie's disease in the penis. A review describes three phases: cells multiply, lumps form, then the tissue matures into firmer, scar-like tissue. An NHS podiatric surgery service notes that it usually progresses slowly, but not indefinitely.

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Who gets itMixed evidence

Mostly middle-aged and older adults, though children can get it. A review says men get it more often than women, and both feet in about a quarter, but in US records of 620 newly diagnosed people, 63% were women, so the sources disagree. About 57 in every 100,000 people in those records had a diagnosis.

Many small lumps are never diagnosed. In an Icelandic study, plantar lumps were found on examination in 15% of 92 men with Dupuytren's contracture and 4% of 101 men without it, and in 730 Dutch men with Dupuytren's, 16% had Ledderhose disease by their surgeons' reports and 22% by their own. Linked conditions in a review include Dupuytren's and Peyronie's disease, keloid scars, frozen shoulder, heavy drinking, diabetes, epilepsy, smoking and repeated injury. The NHS lists a family history, smoking, drinking a lot of alcohol, diabetes and epilepsy as risk factors for Dupuytren's.

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How it shows

A lump you can feel in the arch, firm to the touch, which may not hurt at all. When it hurts, it's usually from shoes pressing on it, more when walking or standing, and standing barefoot can hurt. The lump can stay the same size or grow, and more can appear.

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Scans and biopsies: what they do and don't meanMixed evidence

A clinician can usually diagnose it from the history and an examination; an ultrasound or magnetic resonance imaging (MRI) scan confirms a lump within the fascia if there's doubt. In the largest MRI series, of 196 fibromas, 83% were in the central band of the fascia, 32% of people had more than one, and 52% had pain. So a fibroma on a scan isn't always the cause of foot pain, and many people carry small lumps that never trouble them.

On biopsy, the sources disagree: a US review keeps it for when cancer needs ruling out, while an NHS podiatric surgery service doesn't recommend it, because a biopsy may make the fibroma grow. For a lump that could be something else, the UK route is an ultrasound first, then a specialist if the scan is worrying or unclear. Sarcomas are rare, but a UK foot and ankle unit reported five lumps in the sole first wrongly diagnosed as fibromas.

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How it usually goes

An NHS podiatry service says a fibroma may cause nothing beyond awareness of the lump, and then needs no treatment; over time it may grow without becoming painful. US foot and ankle surgeons (the American College of Foot and Ankle Surgeons) say it usually won't go away or get smaller without treatment. In US records, 91% of newly diagnosed people had only non-surgical treatment over 2 years, and 6.8% had surgery.

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When a lump needs checkingStrong evidence

The NHS says most lumps are harmless, but to see a GP if you're worried or a lump is still there after 2 weeks; if it gets bigger, is painful, red or hot, is hard and does not move, or grows back after it's been removed; and to ask for an urgent GP appointment or get help from NHS 111 for a lump that is very painful, hot or red. A fibroma is firm and fixed, so every new lump in the sole should be checked once.

NICE asks GPs to consider an urgent ultrasound scan, within 2 weeks, for an adult with an unexplained lump that is increasing in size, and within 48 hours for a child or young person, with a specialist referral if the scan is worrying or unclear. The NHS describes a soft tissue sarcoma as a lump that is usually deep, solid, painless and hard to move, and that keeps growing. These are rare, but they are why a growing lump is scanned quickly.

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Shoes, insoles and padding: the main treatment, untestedEmerging evidence

An NHS podiatry service advises a supportive shoe with a fastening, such as a trainer, with more cushioning and depth in the sole and arch, and not completely flat shoes. A podiatrist may prescribe insoles with padding that keeps pressure off the lump, which may ease the pain when standing and walking. An NHS podiatric surgery service lists the same first steps, and US foot and ankle surgeons suggest custom insoles once a fibroma has stopped growing.

A walking study supports the idea: 41 people with painful Ledderhose disease put more pressure through the heel and toes, and less under the middle of the foot, than 41 younger people without foot problems. No trial has compared insoles.

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What exercise can and can't doEmerging evidence

No exercise shrinks or dissolves a fibroma, and none has been tested. An NHS podiatry service says exercises that stretch the calf and the plantar fascia help ease pain in daily activity, and a surgical service says calf stretches may help, especially with insoles. Exercise keeps you active and your calf and foot strong; it can't change the lump. Moves that press on the lump, such as rolling the arch on a ball or kneeling on tucked toes, are best left out (our caution).

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Steroid injections: the sources conflictMixed evidence

Two NHS services say an injection may help only if a nearby nerve is irritated, and is otherwise of little or no benefit and may even make the lump bigger. A US review describes injections as a common first step there, but notes that lumps can return to their original size within 3 years and that repeated injections risk tearing the fascia. In US records, 59% of newly diagnosed people had steroid injections. No trial has tested them.

Sources 1, 3, 2, 4

Radiotherapy: one good trialEmerging evidence

In the LedRad trial, 84 people in the Netherlands had real or sham (dummy) radiotherapy without knowing which. At 12 months, average pain was 2.5 out of 10 after real treatment against 3.6 after sham, and 2.1 against 3.4 at 18 months; 74% against 56% had pain relief at 12 months, with better quality of life and faster barefoot walking. Side effects (redness, dry skin, burning and a short-lived rise in pain) were mild in 95% and had gone in 87% by 18 months.

In 67 people (102 feet) followed for several years after treatment, pain fell from 5.7 to 1.7 out of 10, and 78% were satisfied; 15% had lasting dry skin. It was judged good value for money in the Netherlands. It is one trial, and NICE has no guideline on it, so ask a specialist whether it is offered locally.

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Collagenase and shockwave: not shown to work yetMixed evidence

A collagenase injection, an enzyme that breaks down the tough tissue, missed its main pain target against a placebo in a trial of 166 people, though more people were rated as improved overall and the lumps got softer; a larger trial is under way. Collagenase (Xiapex) isn't available in the UK: its licence was withdrawn in 2020, and NICE has withdrawn its guidance on it for Dupuytren's contracture.

Shockwave therapy has only small studies without a comparison group: pain fell from 6.2 to 0.6 out of 10 in 10 feet, and from about 6 to 1 in 6 people. Other drugs rest on laboratory work and Dupuytren's studies, not plantar fibroma trials.

Sources 21, 22, 23, 24, 25, 26, 2

Surgery: a last resort, because fibromas often come backEmerging evidence

How often a fibroma comes back after surgery depends on the operation and the study. In a review of 6 studies (109 feet), it came back after 67% of operations removing the lump alone, 42% of wider removals with a margin of fascia, and 27% of operations removing the fascia. In another review, the figures ranged from 57% to 100% after removing the lump alone, 8% to 80% after a wider removal and 0% to 50% after removing all the fascia, about 60% overall in that review, and more often with both feet affected, several lumps or a family history. A UK series of partial fasciectomy, removing part of the fascia, had 1 recurrence in 18 people at up to 5 years, and an NHS podiatric surgery service quotes 15% to 50%.

Other risks include a thick or tender scar, numbness, a flatter, achy arch and slow wound healing, and the NHS service warns that when surgery fails, things can be worse than before, with little chance that more surgery helps. In US records, only 6.8% of newly diagnosed people had surgery. A review of 25 studies (233 people) found the evidence for every treatment thin, and called for better trials.

Sources 27, 2, 28, 3, 4, 29

No NICE guideline, because the evidence is thinStrong evidence

In February 2025, NICE decided not to produce a guideline on plantar fibromatosis, because there is very limited evidence on it; it will look at adding it to its clinical summary on Dupuytren's disease. So treatment depends on local specialists, and the advice on this page comes from NHS leaflets, reviews and a few trials.

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Shoes, insoles and padding (written steps)

From NHS podiatry and podiatric surgery leaflets, with our suggestions marked.

• 1. Wear a supportive shoe with a fastening, such as a trainer, with cushioning and depth in the sole and arch, and avoid completely flat shoes.
• 2. Avoid long spells standing barefoot on hard floors while it's sore (our suggestion: standing barefoot can hurt).
• 3. Ask a podiatrist about an insole with padding that takes pressure off the lump; a soft gel or foam insole is a reasonable start meanwhile (our suggestion).
• 4. Pad around the lump rather than on top of it (our suggestion, as in our ganglion cyst and accessory navicular guides).
• 5. Give each change 2 to 4 weeks before judging it (our suggestion).

Sources 1, 3

After plantar fibroma surgery (as your team allows)

One NHS podiatric surgery service's typical timeline. Your team's plan comes first, and the weeks are typical, not deadlines.

• 1. Days 0 to 4: complete rest with the foot up, walking only to the bathroom on crutches. Keep the leg moving: ankle circles, 10 slow circles each way (the move page's dose), and thigh tightening, 10 a few times a day (editorial).
• 2. At the dressing checks, at about 3 to 5 days and 2 weeks, you're shown exercises. Do a little more each day: the service's rule is that pain means you are doing too much.
• 3. About 3 weeks: the stitches come out of the sole. Many people are back in shoes by then, and some only at 6 to 8 weeks. Start stage 1 once the wound has healed and your team agrees (editorial).
• 4. 3 to 8 weeks: back to work (later for active jobs), and driving once you can make an emergency stop. Stage 2.
• 5. From about 3 months: sport can be considered, which is stage 3. A final review at 3 to 6 months; healing is complete at about 12 months.

Source 3

If you have Dupuytren's contracture too

Plantar lumps are more common in people with Dupuytren's contracture, and in the Icelandic study they were more likely in men with bent fingers or previous hand surgery, or a family history of Dupuytren's. Mention both to your GP. Our Dupuytren's contracture guide covers the hand.

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Plantar fibroma or plantar fasciitis?

Plantar fasciitis is pain between the arch and the heel, worst with the first steps in the morning or after resting. A plantar fibroma is a lump you can feel within the fascia in the arch, which often doesn't hurt. You can have both, and our plantar fasciitis guide covers heel pain.

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