Injection-based Interventions for Plantar Fibromatosis: A Clinical Evidence Review

Abstract

Surgical management of plantar fibromatosis is commonly used for treatment in advanced or refractory cases; however, high recurrence rates and procedural morbidity have driven interest in non-operative strategies. This review critically examines current evidence on injection-based and adjunctive therapies to clarify their clinical utility. A systematic literature search of PubMed, Embase, and the Cochrane Library was conducted using the term plantar fibromatosis. Studies involving human participants and published in English were included. Evidence was critically appraised across domains of clinical effectiveness, safety, and practical application. Case series were only included when higher-level evidence was not available for a given modality. 

Twenty-six studies met inclusion criteria. Intralesional corticosteroids provided short-term symptom relief but were limited by recurrence. Extracorporeal shockwave therapy (ESWT) consistently improved pain and function across varied protocols with minimal adverse effects. Radiotherapy demonstrated the most robust clinical evidence, including a recent randomised controlled trial reporting significant improvements in pain, mobility, and quality of life at 12 months. Collagenase Clostridium histolyticum (CCH) showed biological activity but remains unreliable, with inconsistent outcomes and no role in current European practice. 

Radiotherapy and ESWT offer the strongest outcomes, while corticosteroids may provide short-term symptom control. CCH remains experimental. Current evidence is limited by small sample sizes and heterogeneous protocols. A stage-based, individualised treatment algorithm may help guide conservative care. Future trials must define long-term effectiveness using objective pain metrics and imaging-based endpoints, while standardising delivery to guide clinical practice.