APMA Conference Coverage

Reported Impacts of Pain and Treatment Satisfaction in Plantar Fibromatosis

Miranda Manier, BA

Key Highlights

  • Pain is the key differentiator of disease burden in plantar fibromatosis, with patients reporting moderate to severe pain facing the most significant quality of life impacts.
  • Most patients have tried multiple treatments, yet many remain dissatisfied with outcomes such as pain relief and recurrence.
  • Patients prioritize treatments that shrink or remove nodules, prevent recurrence, and relieve pain—especially those with higher pain levels.
  • Participants were open to clinical trials and emphasized the importance of allowing assistive devices and orthotics during participation.

A study presented at the American Podiatric Medical Association 2025 Annual Scientific Meeting, in Dallas/Fort Worth, TX aimed to explore the lived experiences of individuals with plantar fibromatosis (PFI), a rare, benign condition involving collagen-rich nodules on the plantar fascia, and highlight meaningful treatment outcomes. Across three studies—survey, focus groups, and individual interviews—the researchers found that pain severity stratified patients’ experiences, with moderate/severe pain correlating with greater functional impairment, mood disturbance, and dissatisfaction with existing treatment options.

PFI, also known as Ledderhose disease, remains poorly understood despite its potential to significantly impair daily functioning and quality of life. The nodules characteristic of PFI, formed by excess collagen types I and III, can cause pain, pressure, and difficulty walking. Treatment remains inconsistent, and the patient experience is underrepresented in current literature. The limited research on the natural history and symptom burden of PFI motivated this study, with a goal to guide future clinical trials for collagenase clostridium histolyticum (CCH), a nonsurgical agent that targets collagen degradation.

Researchers employed a mixed methods approach, combining a 27-item survey (n=67), two focus groups (n=5), and individual concept elicitation interviews (n=19). Participants were adults with self-reported or documented PFI, largely female (58–84%) and White (74–91%), with a wide age range (31–78 years). All three data sources were integrated using a joint display approach to confirm, expand, and synthesize findings across quantitative and qualitative data.

Pain level emerged as the central differentiator among patients. Among survey respondents, 52% reported moderate/severe pain, while 48% experienced no or minimal pain. Of those in pain, 91% reported moderate to severe daily difficulty related to PFI. Common symptoms included pain (particularly at the end of the day), activity limitations, and challenges wearing footwear. Patients linked symptom progression to daily activity and noted variability in pain intensity depending on time of day.

Most participants had been offered one or more treatments, including surgery, radiation, cortisone or verapamil injections, and enzyme therapies. Satisfaction was closely tied to reduced pain, nodule shrinkage, and prevention of recurrence. However, many reported persistent disease, treatment failures, and frustration with health care professionals’ limited knowledge of PFI. Participants expressed strong interest in clinical trials, particularly those that allow orthotics or assistive devices and aim to reduce pain and restore activity levels.

“This work sheds light on the lived experience of PFI and highlights treatment outcomes that matter to patients, such as pain relief and nodule softening,” the study authors concluded.

Reference
Caporusso J, Gottlieb I, Levy J, et al. A phase 1, single-blind, randomized, placebo-controlled dose escalation study to assess CCH vs placebo in patients with plantar fasciitis. Presented at: American Podiatric Medical Association (APMA) Annual Scientific Meeting; July 24-27, 2025; Dallas/Fort Worth, TX. https://www.apma.org/the-national/