PLANTAR FIBROMATOSIS - TREATMENT OF PRIMARY AND RECURRENT LESIONS ANDFACTORS ASSOCIATED WITH RECURRENCE

Plantar fibromatosis is a benign but often problematic foot disorder w hich, when surgically treated, is difficult to eradicate. The purpose of this investigation was to identify epidemiologic factors associated with disease recurrence and to determine which method of treatment mo st successfully eliminated recurrence. A retrospective review of surgi cal pathology reports and clinical histories from 1979 to 1993 was per formed to identify all patients who underwent surgery for plantar fibr omatosis at our institution during that time. Thirty-three feet of 30 patients were identified with a minimum 2-year follow-up. Seventeen fe et underwent surgery for primary lesions, and 4 of 10 that had local e xcision, 1 of 3 that had wide excision, and 2 of 4 that had subtotal f asciectomy (with or without skin grafting) had recurrence. All 16 feet in patients presenting with recurrent lesions had undergone prior loc al excision at other institutions. When combined with patients from ou r institution who underwent a second procedure, 21 feet had surgery fo r recurrent plantar fibromatosis. Of these, three of four had further recurrence when treated with local or wide excision. In feet with recu rrences treated with subtotal fasciectomy, only 4 of 17 had recurrence after the first attempt at such treatment. Average follow-up for all patients was 7.7 years, and all patients with postoperative recurrence s showed evidence of disease within 14 months after surgery (mean, 6.9 months). Factors identified with an increased risk for recurrence wer e multiple nodules, bilateral lesions, and positive family history. In treating recurrent disease, subtotal fasciectomy was more effective t han local or wide excision. This study identified factors associated w ith a significant likelihood of postoperative recurrence in treating p lantar fibromatosis and found subtotal fasciectomy to provide the most successful treatment in eradicating disease in recurrent cases.