Piezogenic Pedal Papules Treatment & Management

Updated: Aug 14, 2017
  • Author: Christopher R Gorman, MD; Chief Editor: William D James, MD  more...
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Treatment

Medical Care

No effective oral or topical medical therapy is available for this condition. Because the problem is strictly cosmetic for most individuals, therapy is rarely needed. Orthotics may be of benefit to symptomatic individuals, and rest and elevation help with symptoms.

Patients with Ehlers-Danlos syndrome (EDS) may be at risk for healing complications following surgical intervention. However, in 2004, Doukas et al [13] reported a nonsurgical approach for piezogenic papules. They injected betamethasone and bupivacaine in equal parts (1-2 mL/injection) into an EDS patient and reported 50% relief of pain with one injection. Three months later, a second injection yielded a further 20% reduction in pain. After 5 more months, a third injection yielded total relief of pain. At 5-year follow-up, the patient remained asymptomatic.

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Surgical Care

The literature does not suggest any effective surgical therapy.

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Consultations

Consultation with an orthopedic specialist or podiatrist may be indicated if the diagnosis is uncertain, if patients are symptomatic, or if a second opinion is desired in patients with disability. Consultation with a cardiologist may be indicated if evidence of mitral valve prolapse is found on examination. [14]

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Activity

Restriction of standing, walking, and running may be helpful for the unusual patient with painful papules. Elevation of the feet temporarily relieves the herniation.

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Prevention

Weight loss and avoidance of prolonged standing may be helpful for symptomatic patients if, according to the history, these factors are contributing to the symptoms.

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