Piezogenic papules are benign protrusions in the skin on the heels and are caused by normal fat tissue being pushed through the dermis or the inner layer of the skin. Piezogenic papules typically develop on the bottom of the heel and are usually seen on the inside part of the heel. The heel endures an enormous amount of pressure and body weight during gait. The word piezogenic means “resulting from pressure.”
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Symptoms
Piezogenic papules are usually asymptomatic. Pain can indicate fat necrosis due to lack of blood circulation. These papules will be firm but compressible, yellowish to skin-coloured bumps that protrude from the edges of the heel. They become more prominent when standing in a full weight-bearing position and will be less noticeable when non-weight bearing.
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Causes
The specific cause of piezogenic papules is not known but it is known they do not typically run in families and are not usually serious or painful. If piezogenic papules are seen in a toddler, it could be a red flag for a connective tissue disorder known as Ehlers-Danlos Syndrome. A heavy heel strike when walking and standing for long periods of time can both cause piezogenic papules to form in the heel.
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Treatment
The most effective way of getting rid of piezogenic papules is reducing weight-bearing exercise(e.g. trade in the treadmill for a bike), losing excess weight if needed and wearing compression socks. A biomechanical assessment by a lower limb clinician is important as the cause can be determined. Custom foot orthotics can help to reduce the pressure and strain on the heel when walking. Footwear with added cushioning will provide shock absorption and can help to protect the heel from injury. Both BioPed Chiropodists and Pedorthists can help you with orthotics and footwear needs.
