Bilateral Precalcaneal Congenital Fibrolipomatous Hamartoma in a One-Year-Old Child: A Case Report

Precalcaneal congenital fibrolipomatous hamartomas (PCFH) are rare, benign lesions of infancy that present as painless plantar heel nodules and are often identified incidentally. Misidentification may lead to unnecessary investigation or intervention. We report a case of PCFH in a one-year-old child referred for ultrasound assessment of bilateral heel nodules noticed at birth, which became more visually prominent over time. Clinical examination demonstrated soft, non-tender nodules on the heels with normal overlying skin. USG demonstrated bilateral, avascular, subcutaneous fibrofatty lesions representing focal prominence of the plantar fat pad, with no evidence of a well-defined, encapsulated tumour; no biopsy was performed. Given the typical clinical and sonographic features, a clinical and radiological diagnosis of PCFH was made, and the child was discharged back to the care of the general practitioner. This case highlights that recognising the typical features of bilateral congenital heel nodules can prevent unnecessary invasive investigations in asymptomatic children and reinforces the value of a clinical and radiological approach for clinicians who may encounter such lesions.