Indian Journal of Dermatology
  Publication of IADVL, WB
  Official organ of AADV
Indexed with Science Citation Index (E) , Web of Science and PubMed
 
Users online: 6962  
Home About  Editorial Board  Current Issue Archives Online Early Coming Soon Guidelines Subscriptions  e-Alerts    Login  
    Small font sizeDefault font sizeIncrease font size Print this page Email this page


 
Table of Contents 
CORRESPONDENCE
Year : 2016  |  Volume : 61  |  Issue : 2  |  Page : 227-228
Pedal poppers: Soles to hold


Department of Dermatology, Krishna Institute of Medical Sciences, Karad, Maharashtra, India

Date of Web Publication1-Mar-2016

Correspondence Address:
Balkrishna Nikam
Department of Dermatology, Krishna Institute of Medical Sciences, Karad, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.177763

Rights and Permissions



How to cite this article:
Nikam B, Kaur H, Jamale V, Kale M. Pedal poppers: Soles to hold. Indian J Dermatol 2016;61:227-8

How to cite this URL:
Nikam B, Kaur H, Jamale V, Kale M. Pedal poppers: Soles to hold. Indian J Dermatol [serial online] 2016 [cited 2021 Oct 25];61:227-8. Available from: https://www.e-ijd.org/text.asp?2016/61/2/227/177763


Sir,

Piezogenic (Peizo – pressure, genic – giving rise to) pedal papules, usually present as skin colored painless bumps on the heel. These result from herniation of subcutaneous fat through connective tissue defects into the dermis. However, if painful, they can be distressing and difficult to treat.

A 20-year-old girl presented with painful lesions on both heels since 15 days. There was a history of aggravation of pain on walking or standing for long periods. Clinical examination revealed multiple skin-colored papules on the medial aspect of heels giving it a cobblestone appearance. The papules were approximately 8–10 in number on each heel, 3–8 mm in diameter, soft in consistency and became prominent on standing or applying pressure [Figure 1]a and disappeared on lifting the foot off ground and lying down [Figure 1]b. Skin biopsy from a papule suggested fragmentation of dermal elastic fibers with herniation of subcutaneous fat into the dermis [Figure 1]c and [Figure 1]d. On the basis of clinical and histopathological findings, a diagnosis of painful piezogenic pedal papules was made. The possibility of any associated hereditary connective tissue disease was ruled out clinically. No orthopedic abnormality was found on imaging. The patient was counseled to avoid prolonged standing and was provided satisfactory symptomatic management with “Micro-Cellular Rubber (MCR) insoles with a heel raise” [Figure 2].
Figure 1: (a) Lesions become prominent on pressure (b) lesions disappear on lifting the foot off ground (c) fragmentation of elastic fibers (H and E, ×10) (d) herniation of subcutaneous fat in dermis (H and E, ×40)

Click here to view
Figure 2: Microcellular rubber insoles with a heel raise

Click here to view


Painless piezogenic pedal papules often go unnoticed as they are symptomless. They represent normal peripheral fat chambers of the heel. They become painful only when there is entrapment of fat and its neurovasculature resulting in ischemia and anoxia. Though most often idiopathic, common associations of this entity include obesity, flat feet, excessive weight bearing, trauma, and collagen defect disorders such as Ehler–Danlos syndrome.[1] Xanthomas, tophi, and infantile pedal papules comprise the frequent clinical differentials.[2]

Painful piezogenic pedal papules are a therapeutic hurdle for the dermatologist. Conservative treatment measures include weight loss, avoiding standing for long periods, and reducing foot trauma. Various case reports suggest the use of compression stockings,[3] foam-fitted plastic heel cups,[3] local electroacupuncture,[3] combination of a steroid and anesthetic injections,[4] low-level laser light therapy [1] and even surgical excision [5] with variable success. However, we were able to manage this recalcitrant condition both successfully and conservatively with “MCR insoles with a heel raise.” The therapeutic aim is to prevent the excessive trauma caused with a hard sole and to redistribute the weight to the anterior part of the foot by increasing the thickness of the insole over the heel area. This will prevent herniation and resultant entrapment of fat. MCR footwear and insoles can be looked upon as a cheap and effective therapeutic option for institutional management of painful piezogenic pedal papules.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Karadaglic D, Mijailovic B. Painful piezogenic pedal papules – Successful low level laser therapy. Acta Dermatovenerol APA 2001;10:99-101.  Back to cited text no. 1
    
2.
Greenberg S, Krafchik BR. Infantile pedal papules. J Am Acad Dermatol 2005;53:333-4.  Back to cited text no. 2
    
3.
Ma DL, Vano-Galvan S. Piezogenic pedal papules. CMAJ 2013;185:E847.  Back to cited text no. 3
[PUBMED]    
4.
Doukas DJ, Holmes J, Leonard JA. A nonsurgical approach to painful piezogenic pedal papules. Cutis 2004;73:339-40, 346.  Back to cited text no. 4
    
5.
Karadag AS, Bilgili SG, Guner S, Yilmaz D. A cases series of piezogenic pedal papules. Indian Dermatol Online J 2013;4:369-71.  Back to cited text no. 5
[PUBMED]  Medknow Journal  


    Figures

  [Figure 1], [Figure 2]



 

Top
Print this article  Email this article
 
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (763 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    References
    Article Figures

 Article Access Statistics
    Viewed2567    
    Printed14    
    Emailed0    
    PDF Downloaded64    
    Comments [Add]    

Recommend this journal