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A 56 year old woman presented with a hard subcutaneous mass in the plantar aspect of the right foot. This isolated mass demonstrated slow growth over four months, but there was no local pain or fever. On magnetic resonance imaging (MRI), the tumour was demonstrated as a subcutaneous mass with low signal intensity both on T1 and T2-weighted images (figs 1 and 2, arrows), indicating fibrous matrix. The mass showed marked enhancement on enhanced T1-weighted image (fig 3, arrow), contained a cystic change (not shown), and broadly adjoined the flexor hallucis longus tendon (arrowheads). At surgery, a white hard mass with a cavity was found to arise from the plantar aponeurosis. Histological examination revealed a benign reactive proliferation of dense collagenous matrix with markedly enlarged vessels. There has not been any recurrence for 18 months after surgery.
Plantar fibromatosis (Ledderhose disease) is a benign but infiltrative neoplasm, and is a slow growing nodular thickening that occurs most often within the central band of the plantar aponeurosis. MRI is especially useful in planning surgical treatment by showing the exact location and extent of the lesion.