Plantar fibromas are benign fibrous nodules that form in the arch of the foot, specifically within the plantar fascia. While these nodules are non-cancerous, they can cause discomfort and pain, especially when walking or standing for prolonged periods. Traditional treatments have ranged from orthotic devices and physical therapy to invasive surgical procedures. However, a less invasive and increasingly popular option is the use of topical verapamil.
What are Plantar Fibromas?
Plantar fibromas are fibrous knots of tissue that develop along the plantar fascia, the band of tissue that runs along the bottom of the foot from the heel to the toes. These nodules can vary in size and number, and while some people may have just one fibroma, others might develop multiple nodules. The exact cause of plantar fibromas remains unclear, but factors such as genetics, trauma to the foot, and overuse may contribute to their formation.
Traditional Treatment Options
Treatment for plantar fibromas traditionally includes conservative measures such as:
Orthotics: Custom-made shoe inserts to offload pressure from the fibroma.
Physical Therapy: Techniques to stretch and strengthen the foot muscles and alleviate pressure on the fibroma.
Steroid Injections: Corticosteroid injections to reduce inflammation and pain.
Surgery: In severe cases, surgical removal of the fibroma, though this carries a high risk of recurrence.
The Role of Verapamil
Verapamil is a calcium channel blocker typically used to treat high blood pressure and heart-related conditions. However, when formulated into a topical gel, verapamil has shown promise in treating plantar fibromas. Because it is a topical it only works locally on the fibroma. The mechanism by which verapamil helps in this condition involves its ability to inhibit the production of collagen, which is a primary component of fibrous tissue.
How Topical Verapamil Works:
Topical verapamil works by inhibiting collagen production in the area: By reducing collagen production, verapamil helps to prevent the growth of fibrous tissue, thereby reducing the size of the fibroma.
Improving Blood Flow: Verapamil enhances blood flow to the affected area, promoting the healing process and potentially alleviating pain.
Works directly on the area: As a topical treatment, verapamil gel is applied directly to the skin over the fibroma, making it a non-invasive alternative to surgery.
Benefits of Using Topical Verapamil:
Non-Invasive: Unlike surgery, topical verapamil does not require incisions or anesthesia, reducing the risk of complications.
Ease of Use: Patients can apply the gel at home, making it a convenient option for ongoing treatment.
Minimal Side Effects: Topical application minimizes systemic absorption, thereby reducing the risk of side effects typically associated with oral medications.
How to Use Topical Verapamil
The typical application involves applying the gel to the affected area twice daily. It is important to follow the healthcare provider’s instructions regarding the dosage and duration of use. Patients should monitor the site for any signs of irritation or allergic reactions and report these to their healthcare provider.
Combining Topical Verapamil with Hyaluronidase Injections for Large Plantar Fibromas
For larger plantar fibromas, a combination treatment using hyaluronidase injections along with topical verapamil has shown to be particularly effective. Hyaluronidase is an enzyme that breaks down hyaluronic acid, a substance that contributes to the gelatinous structure of fibrous tissue. By disrupting this structure, hyaluronidase helps to reduce the size and density of fibromas.
How the Combination Works:
Hyaluronidase Injections: Administered directly into the fibroma, these injections help to break down the extracellular matrix, making the fibroma less dense and more susceptible to treatment.
Topical Verapamil: Following hyaluronidase injections, the application of verapamil gel further inhibits collagen production, enhancing the reduction of fibroma size and preventing recurrence.
Benefits of the Combination Approach:
Enhanced Effectiveness: The combined use of hyaluronidase and verapamil can more effectively reduce larger fibromas than either treatment alone.
Synergistic Action: Hyaluronidase prepares the fibroma by breaking down its structure, allowing verapamil to penetrate more effectively and exert its collagen-inhibiting effects.
Improved Comfort: This combination can lead to faster and more significant relief of symptoms, improving the patient’s comfort and mobility.
Topical verapamil presents a promising treatment for plantar fibromas, offering a non-invasive alternative to traditional treatments. By inhibiting collagen production and improving blood flow, verapamil can help reduce the size of fibromas and alleviate associated pain. For larger fibromas, the addition of hyaluronidase injections can enhance the treatment’s effectiveness, providing a powerful combination to tackle these stubborn nodules.
If you found this article helpful or have any further questions about the treatment of plantar fibromas, feel free to reach out. Taking steps to address foot health can lead to a more comfortable and active lifestyle.