Written by: Cherri Choate, DPM
7/21/2010

Plantar fibromas are common findings in the foot.  Although these benign soft tissue masses are often not overly painful, they are usually sensitive.  What types of accommodations can be done within an orthotic for these small masses?  I would say, there are three different ways to address plantar fibromas:
     1)  Off-load area
              This can be accomplished by either a sweet spot or a modified sweet spot.  A typical sweet spot is an indentation in the plate that is filled with a softer material such as Poron.  A modified sweet spot would be the same indentation, but it would not be filled with Poron.  If a modified sweet spot is ordered, it should be explained to the lab so they make the "modification" as you want it. 
     2)  Decrease pronation
              As the foot becomes more pronated, the plantar fascia becomes tighter, leading to a more prominent position for the lesion.  By controlling foot pronation the plantar fascia remains less taut.  Pronation control can be accomplished by a variety of means:  firmer plate, deep heel cup, wide plate, medial skive.
     3)  Cushion
             The addition of a topcover can make a big difference for these patients.  The choices of topcovers are bountiful, but I would lean toward one that offers optimal cushioning, such as poron or nylene.  

By combining both local factors that decrease external pressure, as well as functional factors that control of pronation, plantar fibromas can be accommodated well with functional orthotics.
 

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