P14 Bilateral plantar nodules in toddlers: a case series highlighting diagnostic nuances and a reassuring clinical course.

Abstract

Two male children, aged one and two years, were referred for evaluation of asymptomatic, skin-coloured, subcutaneous nodules on the medial aspects of both soles, located just distal to the calcaneal prominence. The lesions had been present since early infancy and grew proportionally with each child, both of whom were otherwise developmentally normal. An initial ultrasound performed at an outside institution suggested a possible vascular malformation, prompting a referral to our tertiary centre. Subsequent high-resolution ultrasonography revealed normal soft tissue architecture with no evidence of a vascular anomaly. The clinical presentation was pathognomonic for bilateral precalcaneal congenital fibrohamartoma (PCFH). These cases illustrate two key points. First, they exemplify the typical natural history of PCFH: a benign, congenital, and non-progressive lesion that requires no intervention beyond reassurance. Second, they highlight a known diagnostic pitfall, as the fibrofatty tissue of a PCFH can generate ambiguous sonographic signals, potentially leading to initial misdiagnosis and unnecessary investigations. Specialist recognition is therefore crucial. Although not universally recognised, PCFH is a relatively common benign paediatric soft tissue lesion. It is typically a clinical diagnosis, but its presentation can be mistaken for other pathologies, which may cause unnecessary parental anxiety. These classic cases underscore the importance of accurately identifying this entity. Ultimately, this case series reinforces that bilateral, asymptomatic PCFH is managed conservatively and does not require long-term follow-up.