What is a Fibroma?
A fibroma is a swelling in the sole of the foot. It is usually in a layer of the foot called the plantar fascia. It consists of a firm nodule or swelling of scar like tissue.
Fibromas can occur either as single lumps, or a collection of lumps. The same disease exists in the hand, where it is known as Dupuytren’s Disease. Often, patients who have a plantar fibroma have coexisting Dupuytren’s Disease in their hands.
The swelling can cause pain and irritation, as it is forms a pressure point on a shoe. Unyielding shoes feel worse, and training shoes may feel more comfortable.
Fibromas are not the only cause of swellings in the sole of the foot. There are several causes that can only be differentiated by tests such as an MRI scan.
If you think that you have a fibroma, it is best to see an orthopaedic surgeon who specialises in foot and ankle surgery. Xrays may demonstrate if there is another cause for the swelling, but commonly an MRI scan is performed if there is any doubt, so that your mind can be put at rest.
How is the Surgery Performed?
Surgery for a fibroma is not common in my practice. There is a high risk of recurrence of the fibroma, and of the recurrence is often worse than the original problem.
Excision can be successful, but it is preferable to have insoles rather than surgery, especially if symptoms are mild.
However, if suitable insoles are unable to allow reasonable comfort when standing or walking, then surgery can be considered, but taking into account the risks of recurrence.
Surgery is carried out under general anaesthetic, but and this is augmented with local anaesthetic injections behind the knee or around the ankle. The injections are normally given while you are asleep for your comfort. They can give good pain relief for the first day after the operation. You can go home the same day in the evening.
Risks of Surgery
Bleeding, infection, poor bone healing, poor skin healing, injury to tendons, injury to nerves, recurrence, and a need for further surgery. The risk of recurrent fibromata, which can be worse than the original condition, is the reason we shy away from surgery if possible, although many patients do have successful surgery.
There is a small risk of blood clots in the legs or lungs (DVT and PE), and there are also risks from anaesthesia – the process of being put to sleep for your operation.
Risks of Anaesthesia
The injection behind your knee is given using an ultrasound machine to guide the needle. There is a less than 1% chance of injury to the nerve. General anaesthetic also carries risks. These risks are proportional to your general health. You will need to be assessed for your fitness for surgery and an Anaesthetist will be able to advise you on your individual risk.
You will have had injections to numb your foot so that you are not in pain after the operation. This injection will wear off after 18-24 hours, so you must take regular painkillers so that you are not in severe pain when the injection wears off.
The pain will settle over a few weeks. You may see blood stains on the dressings. This is normal and not a cause for alarm. If blood is dripping from the dressings however, return to hospital.
The foot will be swollen as well as sore. You should keep the foot elevated as much as possible for the first two weeks. Keep walking down to a minimum – going to the toilet or for meals. Letting the leg hang down will cause the foot to become more swollen.
If you are resting on your sofa, keep your foot elevated on the back rest or arm rest. If you are resting in bed, then place a few pillows under the foot to keep it elevated.
You have been given a postoperative shoe that is for your comfort when you walk, as you will not be able to fit into a normal shoe with heavy dressings applied. Crutches are for balance only.
You should keep all the joints as mobile as possible. Drawing the alphabet in the air with your foot should move all the joints adequately to prevent stiffness.
RETURNING TO WORK
You will be wearing the special shoe for two weeks. I advise that you do not return to work before this, especially if you are on your feet all day at work. We will remove your stitches and we should have a lab report to confirm that the lump taken out was indeed a fibroma. Most people can return to work after that and drive once they are able to fit back into a normal shoe. Remember that not everyone is the same, and some people take a longer time to recover from their surgery. Please request a sick note before you leave hospital, if you need one.