A Pilot Study of a Novel Treatment Method for Refractory Painful Plantar Fibromas

Introduction: Painful plantar fibromas may make ambulation difficult for patients. They may recur and can make shoe wear difficult to purchase. Treatment modalities may include conservative care, modified shoe wear, injections and orthotics. Surgical treatment may include open excision. The TX1A probe by Tenex Inc may be a useful alternative treatment modality for these painful lesions. Materials and Methods: From 2011 through 2014, eight patients who had painful plantar fibromas elected to undergo definitive treatment for the fibromas. They all had had conservative care including modifications of shoes and either over the counter orthotics or custom orthotics. They all had advanced imaging tests (MRI or CT) preoperatively to help delineate the lesions. The definitive treatment utilized arthroscopy and the TX1A probe and was performed on an outpatient basis. Results: Preoperative AOFAS score was 30.8 (20-36). Postoperative AOFAS score was 90.1 (85-92). Average time of resolution of symptoms was 63.5 days (30-112) and average follow-up was 2.5 years. One patient had another lesion become painful but it was in a different location than the index operation. No others have had a recurrence to date. Pathology specimens were all negative for malignancy. All patients were discharged from care. No infections were recorded. Conclusion: The TX1A probe by Tenex Health appears to be a safe, effective method for removing painful plantar fibromas in patients who have failed all conservative measures. Surveillance is ongoing.