History
In most cases, lesions are asymptomatic and are noticed incidentally by affected individuals. Lesions persist and no treatment is required; however, painful papules may be noticed because of associated symptoms.
If the condition is painful, patients may report limitation of occupational or sporting activities.
Piezogenic papules may be more common in people who are overweight, people with flat feet, and people who spend significant time on their feet.
Adult piezogenic pedal papules are more common in women than in men.
Piezogenic pedal papules were seen in 34% of a series of patients with Ehlers-Danlos syndrome (EDS), probably resulting from the underlying connective tissue defect.
Physical Examination
The signs of the condition include herniated papules of fat, usually compressible, mostly in the lateral heels. Examine patients standing with their full weight on the heels. Papules may be present on the medial, posterior, and lateral aspects of the heels. They usually occur bilaterally. The papules are typically 2 mm in diameter.
Papules resolve when the weight is removed. Similar papules may arise on the volar wrists when pressure is applied.
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Piezogenic pedal papules. Courtesy of DermNet New Zealand (https://www.dermnetnz.org/assets/Uploads/dermal-infiltrative/piezogenic-papules5.jpg).
