Piezogenic Pedal Papules

Updated: Aug 14, 2017
  • Author: Christopher R Gorman, MD; Chief Editor: William D James, MD  more...
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Piezogenic papules are painful or asymptomatic papules of the feet and wrists that result from herniation of fat through the dermis. They are common, nonhereditary, and usually are not the result of an inherent connective tissue defect. Piezogenic papules of the wrist were reported in 1991. [1] They are found in a large number of asymptomatic people. See the image below.

Piezogenic pedal papules. Courtesy of DermNet New Piezogenic pedal papules. Courtesy of DermNet New Zealand (https://www.dermnetnz.org/assets/Uploads/dermal-infiltrative/piezogenic-papules5.jpg).


Herniation of fat into the dermis causes the papular appearance. The papules become apparent when an individual stands with full weight on the heels, and they resolve when the weight is removed. The papules, which usually occur bilaterally, may be present on the medial, posterior, and lateral aspects of the heels. Similar papules arise on the volar wrists when pressure is applied.

The histology is similar in both wrist and heel papules, revealing fragmentation of dermal elastic tissue and herniation of subcutaneous fat into the dermis.

Usually, no hereditary diseases or syndromes are associated with the papules, although they have been reported in some patients with Ehlers-Danlos syndrome (EDS). [2]



No specific causes are attributed to the herniation. The condition has occurred within families, [3] but most cases are believed to be sporadic. Piezogenic papules may be more common in people who are overweight, as well as in individuals with orthopedic problems including flat feet. However, they also can occur in newborns with no clear predisposition. Piezogenic papules may occur more commonly in persons with collagen disorders such as Ehlers-Danlos syndrome (EDS).




United States

In the United States, 76% of a studied population has been found to have pedal papules; 86% have wrist papules. These occur in all age groups. Most patients are asymptomatic, although the papules can be painful. Painful papules were found in approximately one third of 29 patients with Ehlers-Danlos syndrome (EDS).


Piezogenic papules occur worldwide. Both American and European studies report an incidence of approximately 10-20% in the populations studied. In a report from India in 1995, 100 people were examined for piezogenic papules. Of these individuals, 80 had pedal papules, 86 had wrist papules, and 74 had both pedal and wrist papules. [4]


No evidence exists of racial or hereditary predisposition, except in piezogenic papules that arise in association with EDS.


Painful piezogenic papules are reported more frequently in women than in men.


Painful papules occur in persons of any age, even children. Infantile pedal papules are seen in 6% of newborns and 40% of infants. Infantile pedal papules differ from adult piezogenic papules. Infantile pedal papules are nodules, occur in the medial plantar aspect of the foot, and lack a piezogenic factor. [5, 6]



In most patients, the condition is of cosmetic concern only. Painful papules are less common and may correlate with Ehlers-Danlos syndrome (EDS), obesity, and occupational or sporting exposure. Painful papules can limit participation in sports and may affect occupational activity. [7, 8]