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  Table of Contents  
Year : 2015  |  Volume : 6  |  Issue : 6  |  Page : 422-424  

Multiple nodules on the sole of the foot

1 NYIT-College of Osteopathic Medicine, New York, USA
2 Ackerman Academy of Dermatopathology, New York, USA
3 Polley Clinic, Wilson, North Carolina, USA

Date of Web Publication17-Nov-2015

Correspondence Address:
Dirk M Elston
Ackerman Academy of Dermatopathology, 145 E, 32nd Street, 10th Floor, New York
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2229-5178.169720

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Ledderhose disease, or plantar fibromatosis, is a benign hyperproliferative disorder of the plantar aponeurosis. It presents as one or more round, firm slow-growing plaques or nodules on the plantar surface of the foot, typically on the medial side. The etiology is unknown, though it has been associated with trauma, liver disease, diabetes mellitus, epilepsy and alcoholism. Histopathological examination of plantar fibromatosis reveals dense fibrocellular tissue with parallel and nodular arrays of fibrocytes and fibrillar collagen with a distinctive cork-screw morphology. The differential diagnosis includes various fibroblastic and myofibroblastic proliferations.

Keywords: Ledderhose disease; Plantar fibromatosis; Superficial fibromatosis

How to cite this article:
Miceli AJ, Junkins-Hopkins JM, Polley DC, Elston DM. Multiple nodules on the sole of the foot. Indian Dermatol Online J 2015;6:422-4

How to cite this URL:
Miceli AJ, Junkins-Hopkins JM, Polley DC, Elston DM. Multiple nodules on the sole of the foot. Indian Dermatol Online J [serial online] 2015 [cited 2021 Jun 19];6:422-4. Available from: https://www.idoj.in/text.asp?2015/6/6/422/169720

A 73-year-old male presented with nodular lesions on the plantar surface of the right foot [Figure 1]. Overlying hyperkeratosis was present. A 6 mm punch biopsy of the plantar surface of the right foot was performed, demonstrating psoriasiform epidermal hyperplasia, hypergranulosis, and hyperkeratosis [Figure 2]. The dermis revealed a spindle cell proliferation featuring fascicles of spindle cells with cork-screw nuclei and fibrillar cork-screw bundles of collagen [Figure 3] and [Figure 4]. Immunohistochemical stains were positive for desmin and negative for S-100, CD68, smooth muscle (SM) myosin and h-caldesmon. An immunostain for human papilloma virus was negative.
Figure 1: Nodular lesion of the plantar surface of the right foot

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Figure 2: Central invagination of the epidermis with psoriasiform hyperplasia, hypergranulosis, and hyperkeratosis (H and E, ×20)

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Figure 3: Spindle cell proliferation of dermis with wavy nuclei and fibrillar bundles of collagen (H and E, ×100)

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Figure 4: Spindle cell proliferation of dermis with wavy nuclei and fibrillar bundles of collagen (H and E, ×600)

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The lesion most likely represents:

  1. Nodular fasciitis
  2. Ledderhose disease (plantar fibromatosis)
  3. Low grade fibromyxoid sarcoma
  4. Neurofibroma
  5. Cutaneous Leiomyosarcoma

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   References Top

Ledderhose G. Über zerreisungen der plantarfascie. Arch Klin Chir 1894;48:853-6.  Back to cited text no. 1
Goldblum JR, Fletcher JA. Superficial fibromatoses. In: Fletcher CD, Unni KK, Mertens F, editors. Pathology and Genetics of Tumours of Soft Tissue and Bone. 2nd ed. Lyon, France: International Agency for Research on Cancer; 2002. p. 81-2.  Back to cited text no. 2
Fetsch JF, Laskin WB, Miettinen M. Palmar-plantar fibromatosis in children and preadolescents: A clinicopathologic study of 56 cases with newly recognized demographics and extended follow-up information. Am J Surg Pathol 2005;29:1095-105.  Back to cited text no. 3
Montgomery E, Lee JH, Abraham SC, Wu TT. Superficial fibromatoses are genetically distinct from deep fibromatoses. Mod Pathol 2001;14:695-701.  Back to cited text no. 4
Farsetti P, Tudisco C, Caterini R, Bellocci M. Ledderhose's disease: Case study with histologic and ultrastructural analysis. Ital J Orthop Traumatol 1992;18:129-33.  Back to cited text no. 5
Evans HL. Multinucleated giant cells in plantar fibromatosis. Am J Surg Pathol 2002;26:244-8.  Back to cited text no. 6
Hasegawa T, Hirose T, Kudo E, Abe J, Hizawa K. Cytoskeletal characteristics of myofibroblasts in benign neoplastic and reactive fibroblastic lesions. Virchows Arch A Pathol Anat Histopathol 1990;416:375-82.  Back to cited text no. 7
Shum DT, McFarlane RM. Histogenesis of Dupuytren's disease: An immunohistochemical study of 30 cases. J Hand Surg Am 1988;13:61-7.  Back to cited text no. 8
Ceballos KM, Nielsen GP, Selig MK, O'Connell JX. Is anti-h-caldesmon useful for distinguishing smooth muscle and myofibroblastic tumors? An immunohistochemical study. Am J Clin Pathol 2000;114:746-53.  Back to cited text no. 9
Perez-Montiel MD, Plaza JA, Dominguez-Malagon H, Suster S. Differential expression of smooth muscle myosin, smooth muscle actin, h-caldesmon, and calponin in the diagnosis of myofibroblastic and smooth muscle lesions of skin and soft tissue. Am J Dermatopathol 2006;28:105-11.  Back to cited text no. 10
Bancroft LW, Peterson JJ, Kransdorf MJ. Imaging of soft tissue lesions of the foot and ankle. Radiol Clin North Am 2008;46:1093-103, vii.  Back to cited text no. 11
Wapner KL, Ververeli PA, Moore JH Jr, Hecht PJ, Becker CE, Lackman RD. Plantar fibromatosis: A review of primary and recurrent surgical treatment. Foot Ankle Int 1995;16:548-51.  Back to cited text no. 12


  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

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