A fibroma is a benign fibrous tissue tumor or growth, that can occur anywhere in the body, for example in the uterus they're called fibroids. On the plantar, or bottom surface of the foot, they are called plantar fibromas. Unlike plantar warts, which grow on the skin, these grow deep inside on a thick fibrous band called the plantar fascia. When non-surgical measures for treating plantar fibromas, such as orthotics have failed to provide adequate relief of symptoms, surgical removal is a reasonable option. Attempts may be made to surgically remove solitary nodules (a single lump or bump) with wide excision, however there is reported to be a high incidence of recurrence. Multiple plantar fibromas generally require more extensive excision of the entire fibrous band of plantar fascia (known as a Steindler plantar fascial stripping), in order to insure complete removal and prevent recurrence.
Description of the Surgery
The surgical procedure involves a long, often curvilinear, incision on the bottom of the foot. The incision extends from the heel to the ball of the foot. The surgeon will dissect through the fatty tissue layer on the bottom of the foot to expose the thick fibrous plantar fascia. The plantar fascia, which includes the multiple benign fibromas, extends from the bottom of the heel, through the arch, all the way to the ball of the foot. The fascia removal requires careful separation from deeper soft tissue structures, and small nerves. Once the fascia has been removed, the bottom of the foot is stitched closed. Often a drain is placed into the surgical site to help prevent blood and other fluids from collecting there. The surgical wound is bandaged and the patient must remain non-weight bearing on the foot (with crutches) for a minimum of three weeks. Normal post-operative care including rest, ice, elevation, and maintaining a clean surgical site would be followed. The drain is usually removed 3 to 5 days after the surgery. The stitches are removed between 2 and 3 weeks after the surgery.
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The common cause of a painful bump on the back of the heel is called Hagland's deformity. This is due to an enlarged bony prominence on the back of the heel. It can involve the entire back of the heel or just a portion of the back of the heel, usually on the outside portion of the heel. Also called the Pump Bump, it is most common in women and is frequently a result of pressure from the back of the shoe. As the shoe rubs on the back of the heel bone it begins to swell and enlarge. Quite often a bursa will form. A bursa is sack that is created over any bony promance when excessive pressure or friction to the areas occurs. Bursa can be filled with a thick watery like fluid.
Treatment of Hagland's Deformity and Pump Bumps
Treatment consists of removing the pressure and avoiding shoes, which rub on the back of the heel. Orthotics, custom molded shoe inserts, can be useful because they reduce the rocking motion side-to-side of the heel while walking which aggravates the painful area. Cortisone injections can temporarily reduce the pain or eliminate the pain. Surgery can be the treatment of choice if other means to reduce the pressure are unsuccessful.
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