Leiomyomas are smooth-muscle tumors that may be encountered in the practice of podiatric medicine when they affect the arrector pili muscles or the smooth muscle of a vessel wall. In the present case, the lesion was located on the heel, an area with no hair growth; this further supports the diagnosis, as the most likely origin of the lesion was the smooth muscle of a blood vessel. Vascular leiomyomas show a greater predilection for the lower extremities than their superficial counterparts. Surgical excision is the treatment of choice for these benign lesions, whose prognosis is excellent. When a patient presents with a painful mass in the lower extremity, the diagnosis of leiomyoma should be considered.