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Summary A man in his 70s presented with a 6-month history of moderate left foot and ankle pain without a clear mechanism of injury. Initial radiographs obtained during evaluation revealed an incidental lesion within the distal tibia. To further characterise this finding and assess for associated pathology, an MRI was subsequently performed. The MRI demonstrated no acute fracture, severe tendinosis of the peroneus longus tendon at the cuboid tunnel and mild tendinosis at the Achilles insertion. In addition, a multilobulated intramedullary lesion with high T2-weighted signal was identified in the distal tibia, consistent with enchondroma. There were no symptoms attributable to the tibial lesion. The patient underwent a trial of physiotherapy with limited improvement, largely due to poor adherence. Given the incidental nature of the enchondroma and absence of aggressive imaging features, the patient was advised to follow-up with his primary care physician for continued surveillance.