Wednesday, 29 October 2014

Association of Plantar Fasciitis and Plantar Fibroma?

Thanks to everyone on the Facebook group and the Facebook page I have results from over 50 patients on a small survey about plantar fasciitis. On the group we noticed that there seemed to be a high percentage of patients with plantar fasciitis and thought we could  have a quick look and see if the numbers added up. 

So as graph 1 below shows of all the respondents with Ledderhose 45% had plantar fasciitis, bearing in mind that reference 1 says that the average for the States is 10% this would appear to be a meaningful number. 

Graph 1: Percentage of Ledderhose patients with Plantar Fasciitis
On the patient survey that we are conducting (over 2000!!!! responses) frozen shoulder was only present in around 20% of patients and knuckle pads in 13%. This suggests that the above could be a true link. The problem is that the conditions could linked not because they are from the same genetics or pathways (as is thought to be the case with Dupuytren's and Ledderhose) but because one can trigger the other or just coincidence but as a former scientist I don't think that is likely.

Graph 2: Distribution of Plantar Fasciitis onset in Ledderhose patients
If we think about these 2 conditions a link due to proximity could make sense. Plantar Fasciitis is an inflammation and or swelling of the the same tissue as plantar fibromas form on. Plantar fibromatosis is the formation of lumps on this tissue, surely the formation of a lump that is not supposed to be there is likely to cause some swelling and inflammation?

So it could be that rather than patients having plantar fasciitis on its own what they actually have is early stage Ledderhose which presents symptoms highly similar to fsaciitis because of the additional strain put on that part of the body. The results shown in graph 2 indicate that 80% of patients that had the plantar fasciitis start either at the same time or before the Ledderhose which is what we would expect if one was a factor in the other condition. 

On the Facebook page I also had a comment making a good point. The point being that potentially more patients with Ledderhose could have this condition but it has not been diagnosed as any pain etc is being put down to the Ledderhose. This is potentially the case but how can we know? I know that I was told that pain with Fasciitis is when you first get up and first start walking whilst (at least in the initial stages) the pain with a fibroma is likely to build up over the course of a day and get worse.

The results of this small survey are clearly not conclusive however it is certainly interesting that such a high number of Ledderhose patients have this condition and of those that have it most get it either before or at the same time as the Ledderhose.

References:
Reference 1: http://www.aafp.org/afp/2005/1201/p2247.html