Hi, I’m Dr. Ernest Isaacson and you’re about to see a video of an excision of a plantar fibroma. A plantar fibroma is a firm knot of tissue which grows along the plantar fascia. The plantar fascia is a fibrous band of tissue that runs along the bottom of the foot from the heel to the toes and it functions to support the arch. Now you may have heard of the plantar fascia as it’s involved in plantar fasciitis but one of the other pathologies of the plantar fascia is what’s called a plantar fibroma and that is a firm nodule of tissue that develops along the plantar fascia. It is a relatively common occurrence but in some cases it can become painful. Initially we try to treat this with conservative measures such as shoe gear modification and once and a while a cortisone shot but when those measures fail, then we may elect to excise or remove the plantar fibroma and leave as much of the plantar fascia intact as possible. This is a procedure that’s done on an out-patient basis, usually in a hospital or surgery center and the patient will go home generally on the same day as the procedure. After the procedure, the patient is generally kept in a position of non-weight bearing with crutches in order to allow for the incision to heal and that period is about two weeks. This is the procedure that you are about to see.
Now just a word of caution that this is a video of an actual surgical procedure so please use discretion when viewing this video. This is an excision of a plantar fibroma. The plantar fibroma is approached from the bottom of the foot. The type of incision that’s used is what we call a lazy S incision. This allows for a more cosmetic closure and in other types of procedures we approach it in anatomic dissection so we cut through the skin in layers. The initial layer that’s cut is the skin layer, and then the subcutaneous or fat layer. Once this layer is cut then the plantar fibroma comes into view and becomes very visible. The plantar fibroma grows within the plantar fascia, so it can be difficult to separate the fibrous tissue from the normal, healthy plantar fascia. For that reason, generally part of the plantar fascia is sacrificed when removing a plantar fibroma. This also minimizes the chance of a recurrence of the growth after surgery. Once the plantar fascia and the plantar fibroma are identified, the area is carefully dissected. Then, using small scissors or a small scalpel blade, the plantar fibroma is removed and passed from the operative field. The area is then carefully inspected for the presence of any other growths or anything else that might resemble a plantar fibroma or any other abnormal growth.
Once the plantar fibroma has been removed it will be sent to the laboratory for pathologic analysis to confirm the diagnosis of a plantar fibroma. Now that we see the plantar fascia, you can see both ends and they will be sutured together as best as possible to maintain the stability of the plantar surface of the foot. Once that’s completed, the subcutaneous or the layers underneath the skin are sutured together with a dissolving suture. The skin layers are then sutured together with a stronger bond of nylon or a non-dissolving suture in order to hold the skin together and a number of stitches will be used in order to ensure that this incision comes together in a strong and cosmetic way. Once the skin suturing is complete then the foot is wrapped. Generally the first layer of wrapping is a fluffed type of gauze in order to provide cushioning and also to minimize the chances of the incision opening. The wound is then dressed with additional layers of gauze and an ace wrap to provide compression and also to absorb some of the bleeding that inevitably comes out after the procedure. The patient will then be transferred to a recovery room where they will be given a surgical shoe and crutches until they’re discharged from the hospital or surgery center. You’ve just seen an excision of a plantar fibroma. This is a procedure that can be performed on a outpatient basis in a hospital or outpatient surgery center. After the procedure the patient is kept in a non-weight bearing position with crutches for about two weeks. This is to allow the skin on the bottom of the foot which has been cut and sutured to sew without any external pressure on the foot whatsoever. After that initial two week period, the patient is generally allowed weight bearing in a protected state until full healing is achieved.