What are they?

They are categorised by persons as “lumps or bumps” that occur on either or both heels. Piezogenic pedal papules are small white bumps that form on the outside of the heel. These bumps are more prominent when pressure is exerted on your feet when standing. When you lie down or sit, the bumps are not visible as pressure has been removed. These papules are normally painless, however, in some cases, mild to moderate pain does exist with added pressure to your feet.

 Causes

They are a pressure induced herniation of the subcutaneous fat, through the fascial lining of the heel. Fascia is a covering over soft tissue underneath the skin, similar in appearance to saran or plastic wrap. What happens is that the fat herniates or protrudes through small tears in the fascial lining, resulting in nodules or the lumps that are seen in the heel area.

 Who is at Risk?

Anyone, including children, can get piezogenic papules which are non-malignant lesions. They are seen slightly more in women than men. In the small percentage of persons who experience pain from these herniations,  the persons tend to be obese or prone to long periods of standing.

Underlying connective tissue diseases such as Ehlers-Danlos syndrome, flat feet, and excessive weight-bearing exercise tend to be associated with this condition as well.

Additionally, those most likely to form the papules are young, athletic individuals and women, although again, men in this category are also at a lower risk.

How is Piezogenic Papules diagnosed?

There is no lab work or imaging studies that will be able to confirm piezogenic papules. Diagnosis is made solely through physical examination; the fact that:

Papules resolve when the patient is non-weight bearing
Papules can usually be compressed
They mostly occur over posterior and lateral border of the heels
They are often bilateral

 Misconceptions

Although piezogenic pedal papules are diagnosed through physical examination, misdiagnosis is fairly common. In some cases, these bumps have been treated as warts, boils or cysts, despite the fact that they are not filled with fluid, nor are they caused by any virus.

Another misconception regarding piezogenic pedal papules is that they are genetic. Genetics and race have nothing to do with these formations, which can strike anyone at any time.

Considerations

 Repeated trauma to your heels increase your chance for these bumps becoming painful. Another consideration in the risk of experiencing heel pain includes extended periods of standing, such as with work related tasks. You should consult your doctor or podiatrist if you experience severe pain, leaking of fluids, or signs of infection, such as inflammation accompanied by bump tenderness.

Treatment

The first treatment is reassurance that these “growths” are harmless. In those individuals where there is some degree of pain or discomfort, plastic heel cups can be very helpful. These are plastic egg shell shaped devices that are placed around the heel. What they basically do is push the fat back into the fascial defect.

Other conservative management approaches include:

-Restriction of weight-bearing exercise
-Weight loss
-Use of compression stockings
-Use of foam rubber foot pads
-A consultation with a podiatrist

 

Additionally, some doctors may also recommend one or more injections. This is particularly effective if there is a burning component to the pain, as the injections deaden the nerves that end at the level of the papules. This is the same injection that is used for Morton’s neuroma. On very rare occasions they may have to be surgically excised. This is generally limited to instances where there is nerve tissue embedded in the fat that is protruding through the fascial defect, to stop pain and correct your heel’s appearance.

Your feet mirror your general health . . . cherish them!