eMedicine Specialties > Dermatology > Environmental

Black Heel (Calcaneal Petechiae)

Author: Jonathan Baron, MD, Consulting Staff, Dermatology Group
Coauthor(s): Norman Levine, MD, Professor, Department of Medicine, Section of Dermatology, University of Arizona Health Sciences Center
Contributor Information and Disclosures

Updated: Oct 2, 2006

Introduction

Background

Black heel is a self-limited, asymptomatic, trauma-induced darkening of the posterior or posterolateral aspect of the heel that occurs primarily in young adult athletes. It was first described in a group of basketball players in 1961.1 Although clinically insignificant, black heel is important because of its close clinical resemblance to malignant melanoma. A similar lesion termed black palm (tache noir) has been described on the thenar eminence in weightlifters, gymnasts, golfers, tennis players, and mountain climbers.

Pathophysiology

Black heel is caused by a repeated lateral shearing force of the epidermis sliding over the rete pegs of the papillary dermis, resulting in intraepidermal hemorrhage.

Frequency

United States

The exact incidence of black heel is unknown. One study involving 596 19-year-old sports participants revealed an incidence of 2.9%.2 This sports-related dermatosis probably is much more common than has been reported.

Mortality/Morbidity

The lesion of black heel usually is asymptomatic, although both pain and tenderness can occur. The black areas always resolve spontaneously within several months if the traumatic inciting events are discontinued.

Age

Black heel primarily occurs in young adult athletes, but it may appear in persons of any age if the appropriate conditions occur.

Clinical

History

Black heel occurs in adolescents and young adults who participate in sports that involve frequent starts and stops, such as basketball, football, soccer, lacrosse, and racquet sports.

  • Patients present with an irregular dark macule over the heel (see Media File 1).
  • The lesion usually is asymptomatic and does not inhibit the patient from performing routine daily activities.
  • The patient may or may not relate the onset of the lesions to participation in sports.

Physical

Examination reveals a blue-to-black macule or patch ranging in size from a few millimeters to several centimeters in diameter.

  • The posterior and posterolateral heel are affected most commonly.
  • On close inspection, multiple petechiae are centrally aggregated with a few scattered satellite macules.
  • The dyschromia often is in a horizontal distribution; however, both circular and oval lesions may occur.

More on Black Heel (Calcaneal Petechiae)

Overview: Black Heel (Calcaneal Petechiae)
Differential Diagnoses & Workup: Black Heel (Calcaneal Petechiae)
Treatment & Medication: Black Heel (Calcaneal Petechiae)
Follow-up: Black Heel (Calcaneal Petechiae)
Multimedia: Black Heel (Calcaneal Petechiae)
References
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References

  1. Crissey JT, Peachy JC. Calcaneal petechiae. Arch Dermatol. Mar 1961;83:501. [Medline].

  2. Rufli T. Hyperkeratosis haemorrhagica. Hautarzt. Nov 1980;31(11):606-9. [Medline].

  3. Akasu R, Sugiyama H, Araki M, Ohtake N, Furue M, Tamaki K. Dermatoscopic and videomicroscopic features of melanocytic plantar nevi. Am J Dermatopathol. Feb 1996;18(1):10-8. [Medline].

  4. Saida T, Oguchi S, Ishihara Y. In vivo observation of magnified features of pigmented lesions on volar skin using video macroscope. Usefulness of epiluminescence techniques in clinical diagnosis. Arch Dermatol. Mar 1995;131(3):298-304. [Medline].

  5. Hafner J, Haenseler E, Ossent P, Burg G, Panizzon RG. Benzidine stain for the histochemical detection of hemoglobin in splinter hemorrhage (subungual hematoma) and black heel. Am J Dermatopathol. Aug 1995;17(4):362-7. [Medline].

  6. Adams BB. Dermatologic disorders of the athlete. Sports Med. 2002;32(5):309-21. [Medline].

  7. Cho KH, Kim YG, Seo KI, Suh DH. Black heel with atypical melanocytic hyperplasia. Clin Exp Dermatol. Sep 1993;18(5):437-40. [Medline].

  8. García-Doval I, de la Torre C, Losada A, Cruces MJ. Disseminated punctate intraepidermal haemorrhage: a widespread counterpart of black heel. Acta Derm Venereol. Sep 1999;79(5):403. [Medline].

  9. Levine N. Dermatologic aspects of sports medicine. J Am Acad Dermatol. Oct 1980;3(4):415-24. [Medline].

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Further Reading

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Keywords

talon noir, tennis heel, hyperkeratosis haemorrhagica, pseudochromhidrosis plantaris, black heel, calcaneal petechiae

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Contributor Information and Disclosures

Author

Jonathan Baron, MD, Consulting Staff, Dermatology Group
Jonathan Baron, MD is a member of the following medical societies: American Medical Association and Arizona Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Norman Levine, MD, Professor, Department of Medicine, Section of Dermatology, University of Arizona Health Sciences Center
Norman Levine, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Medical Editor

Donald Belsito, MD, Clinical Professor, Department of Internal Medicine, Division of Dermatology, University of Missouri at Kansas City; Private Practice, American Dermatology Associates, LLC
Donald Belsito, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, Dermatology Foundation, Kansas Medical Society, Noah Worcester Dermatological Society, Phi Beta Kappa, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Director, Division of Dermatology, Scott and White Clinic; Director Dermatology Residency Training Program, Scott and White Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Edward F Chan, MD, Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine
Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology
Disclosure: elsevier Royalty Other

 
 
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