Piezogenic pedal papules are a benign condition consisting of normal fat tissue that has extruded through the skin in the area of the heel. The papules usually appear on the inner side of the heel; they may also occur near the wrist. They are visible only when standing (weight bearing) and immediately disappear when non–weight-bearing. Occasionally, the papules will be painful but that is rare.
Piezogenic papules are most commonly diagnosed in otherwise healthy patients. Usually, they are not suggestive of systemic diseases.
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Symptoms
Piezogenic papules present with firm, yellowish to skin-coloured papules that protrude from the inside (most common), outside or back aspects of the heel. The papules become more prominent when you stand in a full weight-bearing position and, by definition, go away when you remove weight. They are typically present on both the right and left side. The pain associated with them, which is rare, is felt differently; sometimes as a stinging, burning, or achy sensation.
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Causes
In the rare case when these papules are painful, the pain has been attributed to the herniated fatty tissue having compression to its blood supply. The papules themselves are said to be more common in women, and appear spontaneously. There may a genetic component but this has not been proven. Finally, they can occur at any age and it is said that those who stand for long periods, and those who are obese are more at risk.
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Treatment
If no pain is present, treatment is typically not necessary. However, if pain or discomfort is present, it is recommended to wear compression stockings, orthotics and properly fitted footwear. Also, to avoid standing for long periods of time and consider weight loss if directed by your physician/nurse practitioner.
