Calcaneal Conundrums
Article Outline
An 11-month-old female was referred for evaluation of “knots on feet” since birth. The child had no pain, yet her mother was concerned that the lesions might affect her daughter’s ability to walk. Past medical history was non-contributory, although a cousin had similar nodules on both heels. The result of physical examination was unremarkable except for soft, rubbery, 1-cm nodules on the anterior-medial aspects of both heels. The nodules were skin-colored and non-tender. The child cruised without difficulty and experienced no discomfort when standing.
Precalcaneal congenital fibrolipomatous hamartomas (PCFH) (Figure 1) are benign lesions of unknown cause that often present in the first few months of life or are present at birth.1 The incidence may be as high as 5% in newborns and 39% in infants.2 The lesions are symmetric, bilateral, painless, flesh-colored nodules on the medial aspects of the heels. Although usually asymptomatic, PCFH have been reported to be mildly tender or to cause minor gait abnormalities.1, 3 Although biopsy is unnecessary, PCFH are characterized by lobulated adipose tissue separated by fibrous septa with prominent capillary vessels.4 PCFH should not be confused with adult piezogenic pedal papules (Figure 2), which, unlike PCFH, accentuate with standing.
Figure 1
Precalcaneal fibrolipomatous hamartomas.
Figure 2
Piezogenic pedal papules.
Management should consist of reassurance and observation, because PCFH often regress over time.5 Surgery should not be considered unless the lesions are problematic.
References
- . Precalcaneal congenital fibrolipomatous hamartomas: report of 3 additional cases and discussion of the differential diagnosis. Dermatology. 2009;218:260–264
- . Infantile pedal papules. J Am Acad Dermatol. 2005;53:333–334
- . Bilateral plantar nodules in an infant: diagnosis. Arch Dermatol. 2005;141:1161–1166
- . Precalcaneal congenital Fibrolipomatous hamartomas. Pediatr Dermatol. 2007;24:74–75
- . Precalcaneal fibrolipomatous hamartomas. Clin Exp Dermatol. 2009;34:495–496
PII: S0022-3476(10)01067-X
doi:10.1016/j.jpeds.2010.11.061
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