Anteromedial plantar nodules of the heel in childhood: a variant of the normality?

Abstract

Localized, bilateral, painless, nonpruritic and symmetric papuloid lesions in the posteromedial part of the foot are the clinical features of benign plantar nodules of the heel in children. They are probably congenital; they are asymptomatic and benign. We present 18 children with posteromedial nodules of the heel, 15 bilateral. Mean age was 45.31+/-53.49 months. The reason for the consultation was the lump itself in 10 of the cases. Thirteen were asymptomatic and five presented transient tenderness to pressure. Radiographs were nonspecific in all cases. Sonography showed an accumulation of tissue similar to subcutaneous cell tissue, compatible with fat. MRI was performed in one case, showing an accumulation of fatty tissue similar to subcutaneous cell tissue. Follow-up time was 5.44+/-3.78 years (range 2-16 years). At the end of follow-up, all the patients are asymptomatic with normal functional outcome and with the lump persisting in all but one. In conclusion, a sonographic study is sufficient to diagnose this type of mass, without the need for biopsy and/or surgical exeresis to distinguish fatty tissue from another type of consistency. Subsequent studies should aim at showing piezogenic, hamartomatous or congenital fat herniation aetiology of these typical lumps, probably normal variant of normality.

Cutaneous fibrolipomatous hamartoma: Report of 2 cases with retrocalcaneal location

“…Greenberg et al searched for precalcaneal FLH in 269 newborns and 189 infants and found an incidence of 5.9% in newborns and 4% in infants. Although FLH is usually congenital, some cases, such as ours, have been noted after birth, with 1 diagnosis made as late as 16 years …”

“…A genetic mechanism with an autosomal‐dominant or X‐linked inheritance has been hypothesized, but most cases are sporadic. Single case reports describe an association with Gardner syndrome and tuberous sclerosis .…”

Precalcaneal Congenital Fibrolipomatous Hamartoma

“…Treatment, other than reassurance, is not required, especially for bilateral nodules. Children with unilateral nodules should be scheduled for re-evaluation after 6 month to determine whether the nodule is getting larger or becoming symptomatic 10 . Ultrasonography may also be performed during the evaluation.…”

Hamartoma fibrolipomatoso precalcáneo congénito

“…Clínicamente, se caracteriza por nódulos subcutáneos, blandos, móviles, simétricos, eucrómicos y asintomáticos, localizados en la región plantar antero-medial, inmediatamente anterior a los talones, aunque pueden extenderse a estos. Las lesiones son típicamente de carácter asintomático y no se ha descrito interferencia con la marcha (3)(4)(5)(6)(7) . Es importante aclarar que no se han reportado otras alteraciones asociadas con este trastorno, ni posibilidad de transformación maligna de las lesiones (4) .…”

“…El diagnóstico es principalmente clínico, sustentado en los casos dudosos con biopsia de piel. En esta úl-tima, típicamente, se describe la presencia en la dermis profunda y en la hipodermis de adipocitos maduros, rodeados de edema intersticial con abundante sustancia fundamental y envueltos por fibras de colágeno de grosor variable y fibras elásticas de características normales (2)(3)(4)(5)(6)(7)(8) . Se pueden observar depósitos de mucina en la periferia y entre los lobulillos grasos, así como aumento del número de vasos sanguíneos, sin anomalías perivasculares asociadas (4) .…”