What are Piezogenic Pedal Papules?

When you run your hands over the soles of your feet, the surface should be smooth to touch. However, sometimes, the surface may not be so smooth. Piezogenic pedal papules are papules on the medial, posterior or lateral aspects of both heels and result from herniation of fat. These papules are usually asymptomatic and can range from a size of 2mm to 10mm. In some cases, they can be a little painful. This is seen commonly in large lesions. They become apparent when the patient stands with his full weight on his feet and disappear or shrink when the weight is removed. Piezogenic papules can also occur on the wrists. This is a fairly common condition that affects women more than men. Piezogenic pedal papules can occur at any age including infancy.

There is no known cause for the herniation of fat that causes this condition. However, there are a few factors that could increase your risk of suffering from this condition. These factors are:

• Obesity
• Orthopedic problems
• Flat feet
• Collagen disorders such as EDS
• Jobs which entail standing for long hours
• Excessive weight bearing

This condition can also affect newborn babies with no predisposition. The diagnosis of this condition is often confused with infantile pedal papules, xanthoma and tophi. Since they are prominently visible only when pressure is applied, it is essential for a doctor to physically examine the patient while he or she is standing. This condition does not affect the health of a person and is largely only a cosmetic issue. Thus treatment is not usually necessary but some of the things you could do to relieve the discomfort are:

• In cases where Ehlers-Danlos syndrome triggers the condition, patients may be recommended betamethasone and bupivacaine injections. These injections need to be administered repeatedly for complete pain relief.
• Orthotic soles or custom made inserts for shoes can help relieve the pain and distribute pressure equally.
• Heel taping
• Compression stockings
• Avoid excessive or prolonged weight bearing
• Avoid standing for extended periods and try not to run too much
• Rest the feet and keep them elevated to help alleviate the symptoms
• Lose weight if you are on the heavier side
• Electro acupuncture

Piezogenic pedal papules are benign and are no reason to worry. If they begin to affect the quality of your life, you could consult a podiatrist.