Piezogenic pedal papules

LAST UPDATED: Nov 18, 2021

Introduction

Piezogenic pedal papules are small fatty herniations through fascial defects of the heels. Similar papules can also be found on the wrists and ulnar margins of the hands. Piezogenic pedal papules are common in a healthy population, the incidence is increased in disorders of the connective tissue such as the Ehlers-Danlos syndrome.

The chapter is set out as follows:

History
Clinical findings
Images
Management

History

They are found in all age groups
While the vast majority are asymptomatic, pain on standing is the most common reason for presentation

Clinical findings

Distribution

Bilateral
Heels, especially the medial border

Morphology

Lesions become apparent on standing
Pale to skin-coloured compressible papules and nodules

Clinical Images

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Piezogenic pedal papules

Same patient as…

Management

Step 1: asymptomatic patients

No treatment is required

Step 2: conservative treatment for painful lesions

Advice on avoidance of prolonged standing and a temporary reduction in exercise may be of benefit
Weight loss where appropriate
There appears to be no effective topical or systemic treatment

Step 3: surgery

While the literature does not suggest any effective surgical therapy, surgical excision for a very persistent and painful lesion can be considered

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