Fibromatous nodules occasionally develop in the plantar aponeurosis in a manner consistent with the biomechanical etiology of Dupuytren's contracture. This is of course a benign lesion of the plantar surface of the foot and may appear at any age with the greatest prevalence at middle-age and beyond. Associated fibroblastic clinicopathological predispositions include Dupuytren's contracture, intratendonous fibrous nodules, periathrosis humeri, Peyronie's disease, and keloids, to name a few. Although histological findings suggest a chronic inflammatory process, the etiology is idiopathic. Epileptics seem to be predisposed.
There is a thickening of the plantar fascia due to the formation of a firm, irregular, lobulated mass of small nodules which coalesce into an indurated irregular fibromatous mass. The mass is commonly found in the longitudinal arch and although it does not tend to involve adjacent structures, it does tend to adhere to nearby tendons, muscles, nerves, blood vessels, and overlying integument. This is an inflammatory reaction since lymphocytes and mononuclears are found near the proliferative nodules, although the actual cause is unknown. It may be related to plantar fasciitis, but with intermittent episodes of amelioration and exacerbation which do not allow for progress of the lesion to complete clinical development (an opinion of this writer). This nodular mass enlarges over a period varying from months to years and eventually the patient complains of pain when standing or walking.
In the opinion of this author, if this lesion progresses to the point of forming a fibromatous nodular mass it must be surgically excised, along with the plantar aponeurosis. Failure to remove the aponeurosis, in the presence of such a history, tends to invite recurrences, which are common.
Also, in the opinion of this author, if this lesion is discovered by an astute physician prior to the development of the fibrous nodules and treated vigorously, progression to the point requiring surgical correction may be avoided.
Conservative care involves lidocaine (2.5 percent)/hydrocortisone (1 percent) phonophoresis directly applied to the area of the lesion using the menstruum of the phonophoretic agents as the coupling agent, b.i.d., or p.r.n. to relieve local distress or interfere with the progress of the fibrous network. Pulsed ultrasound is recommended at 0.5 to 0.7W/cm2 for eight minutes per application.
Since a constant finding histopathologically within the developing nodules is the formation of blood vessels, cauterization may be achieved by applying a refrigerant spray directly to the area of the lesion sufficient to achieve this effect clinically. This lesion may prove somewhat intractable to treat, even in the early stages of formation.
References
Davis RV. Therapeutic Modalities for the Clinical Health Sciences, 2nd ed. Copyright -- Library of Congress TXU-389-661, 1989.
Griffin JE and Karselis TC. Physical Agents for Physical Therapists, 2nd ed. Springfield: Charles C. Thomas, 1982.
Krusen, Kottke, Ellwood. Handbook of Physical Medicine and Rehabilitation, 2nd ed. Philadelphia: W.B. Saunders Company, 1971.
Schriber WA. A Manual of Electrotherapy, 4th ed. Philadelphia: Lea & Feibiger, 1975.
Turek. Orthopaedics -- Principles and Their Application, 3rd ed. J.B. Lippincott.
R. Vincent Davis, DC, PT, DNBPME
Independence, Missouri
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
