Plantar fibromas are very common. Not sure why the diagnostic dilemma though as they are very obvious and can usually be diagnosed via simple physical exam. A diagnostic ultrasound can also easily see these as they are generally fairly large by the time they are causing symptoms.

If your MRI ordered from your 2nd specialist "showed a possible tear or a fibroma", then something isn't quite right.

I assume you can easily palpate the fibroma in your arch on the plantar fascia?

Conservative treatment once they are larger, say about an inch, isn't terribly effective for active people in my experience. Orthotics are often not tolerated well since they just put more pressure on the things. Most fibromas don't cause symptoms at all though. If you have failed conservative therapy, then you have 4 options: live with it, intralesional corticosteroid injections, transdermal calcium channel blocker therapy (i.e. verapamil), or surgical excision.

I'll assume you have not heard of the Ca channel therapy, so here you go:
http://www.pdlabs.net/wireless/iphone/plantar_fibromatosis/transdermalverapamil_plantar.html


Surgical excision is fairly easy, but there is a very high rate of recurrence if just "peeling off" the fibroma as you seem to be aware. Taking a piece of the facia around it with the fibroma reduces the risk of recurrence, but then there are possible side effects from that in some cases. Many surgeons use special tissue harvests/grafts after removal as well to limit adhesions/recurrence.


Hope this was helpful.

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Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD

That's one thing that has me a bit confused. I can't see or feel a noticeable lump in the area. When he showed me the MRI you can clearly see what looks like an area of thickening, which looks like some pictures I've seen on the internet of a fibroma. These were different images from what my prior doctor showed me back in May that looked like a tear, but since he mentioned a possible fibroma he just may not have shown me those images. Obviously, I'm not a doctor so I'm not 100% sure of what I'm looking at. I have read about treating with Verapmil gel online, but the ONLY option my doctor presented to me was surgery. I was very discouraged when I left his office. The other thing that has me confused is that the pain in my arch comes on between a half mile and mile into my run. Often if I stop and stretch my feet/arches a couple times the pain will subside so I continue and often will even go away after a couple miles or sometimes shift to forefoot pain It seems like if I really had a fibroma that the pain would stay. I'm just at a loss right now since I've now seen 3 doctors and have tried just about every conservative treatment out there and am no better off then I was a year ago. Thanks for your reply. I'm in Atlanta if you happen to know someone really good here!

I'd wager through my laptop that you don't have a true plantar fibroma then. You likely had some macro tearing of the plantar fascia and it has healed back thickened/scared and that is what you are seeing on the MRI. Based on your description, you are dealing with chronic plantar fasciosis and all the fun that goes along with it :(

The bad news is that you seem to be failing conservative therapy for over 1 year as most cases (> 95%) of plantar fasciitis resolve within 12 months.

Certainly plenty of good specialist in/around Atlanta!

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____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD

You may be right. It's a little odd ot me since I have never had heal pain nor have I ever had any pain or discomfort first thing in the morning. I'm supposedly seeing the best right now in Atlanta. The MRI is the same one from May, so it's possible that the thickening doesn't look the same now. I've debating asking for a new MRI to compare to the one from May. I guess either way, it just feels a little hopeless after all this time and all these treatments. Thanks again for your opinion! I know it's pretty hard to diagnose over the internet, or I appreciate your trying to help!

I got the CD with my MRI images Friday. I looked at them and compared them with online MRI images of plantar fibromas and plantar fasciitis and my uneducated opinion is they far more resemble plantar fasciitis then a plantar fibroma like you said. I think that makes much more sense with my symptoms too. It doesn't look like a lump in the fascia but more like a section that is thickened and tapers off in each direction. But these are from just before I had the PRP injections so I have no idea if they would look any different now. However, that doesn't leave me much more optimistic since I have been battling the arch pain for a couple years how, have done just about every conservative treatment available (but not cortisone or ESWT), including time off. It's so chronic and been going on for so long I'm assuming any type of cortisone injection would be useless. I've already taken a ton of time off so I don't see just not running doing much more to help either. The other foot and ankle surgeon that my doctor recommended won't even see me for a second opinion. He stated I've already seen qualified doctors and he has nothing more to offer. I'm going to try to see a podiatrist who is well known within the running/triathlon community here and hope to get some other answers and solutions, or at worst confirmation of what I've already been told. If I can't get in here then I might be trying to make a trip north to Ohio! :) After over 2 years battling this I'm just ready to find some solution to be able to run without pain again!

Little Red -
I am hoping you are still somewhat active on this forum. Of all of my online research your story closely resembles mine. I have been battling some heal pain for a couple of years now and have resigned to conservative therapy and months of rest from any activities which may stress my tendon.

Would you mind giving me an update of your condition? What did you find out, what has helped, has your condition resolved?

for me shockwave therapy has helped a lot resolve the plantar fasciitis symptoms but the irregular mass on my tendon is still quite uncomfortable and I'm very reluctant to start running again, as much as I want to, I've decided to keep holding off until this issue is resolved because from my experience the pain just returns with any athletic activities.

Any updates could help.
Thanks,
PNW79

I actually rarely come on the Slowtwitch forum, but I got an email noting someone replied to a thread I started. :) These days I mostly do trail running and ultra marathons and ma pretty much out of the tri scene. Well, it's been a very long, frustrating road for me. No, I did not actually have a fibroma. I believe the doctor wasn't reading the MRI correctly - just my guess. I had been having both arch pain and forefoot pain, as well and really tight calves. I ended up having an EMG that was positive for nerve entrapment. I had surgery on both feet to release the tarsal tunnel nerves about 2 years ago. This resolved the forefoot pain but not the arch pain or calf tightness. After continuing to try every treatment imaginable I had surgery again 4 weeks ago. My orthopedic noted that my calves are extremely tight (not just that they feel tight when I run, but no flexibility with my knee straight) - and this is with extensive daily stretching, massage, ART, etc... I had gastrocnemius release and plantar fascia release at the "master knot of Henry" in my arch.(I had never heard about the master knot of Henry this doctor said that is the area of my arch pain - you can google it) I didn't have plantar fascitiis based on the MRI or symptoms, but my doctor felt releasing it where I had the most arch pain should help. I don't know if the fascia was caught at that spot in my arch or exactly what was causing the tightness. I know I'm doing a terrible job explaining exactly what his diagnosis was and it's too early to know if this will resolve my arch pain and calf tightness. I have another follow up appointment next week and I should be able to start running on the alter-G treadmill and then be back on the trails around 6-7 weeks. At least the recovery has been pretty quick. I'm sure all this is absolutely no help to you if you do truly have a firboma .... but based on my experience the foot can be tricky to diagnose and treat! Good luck!

If no palpable mass then I agree with the fasciosis/fasciitis diagnosis. Being a sports med podiatrist, I consider that your best bet. We often know a few 'tricks' that may help.

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Dr Jay
http://www.Tri-Pod.net

Thanks for the update!
I actually don't run Tri myself either. Mostly trail marathons and ultras as well.
Last race I was walking to the start line of a 50miler with my feet already achy and taped up, I just thought enough is enough. I backed out, that was 5 months ago. I had been running with a lump of tissue in my heal for two years and it's just starting to drive me nuts.
I've tried PF protocol for years and although it helps some morning pain symptoms it never does anything about the size and pain from pressure of standing on the thing all day. Honestly I'm about to start begging a surgeon to cut this thing out and roll the dice on recovery. But my doc mentioned dry needling the thing... I don't see this being that helpful.
All doctors say they can help BTW... I've been to four, none have yet.