An 11-month-old girl was referred for evaluation of bilateral plantar nodules that had been present since birth. The nodules increased in size proportionately with the child’s growth. There was concern that the pedal nodules were impeding normal walking, as she consistently stood on her tiptoes and seemed reluctant to bear weight on her heels. She was otherwise healthy and developing normally. Her family history was significant for neurofibromatosis 1 in her mother.
Physical examination revealed bilateral, soft, 1-cm, subcutaneous nodules at the anterior edge of the calcaneus (Figure 1). The nodules did not seem tender to palpation. There were no other skin findings. Magnetic resonance imaging of the feet showed no bony or cartilaginous abnormalities. A punch biopsy specimen was obtained and stained with hematoxylin-eosin (Figure 2).