Several different causes of piezogenic papules may be present in a patient. Glucocorticoids, a type of painless herniation of fat through the dermis, and other causes are listed below. In some cases, no underlying disease is present. In this situation, a patient may experience pain and a swollen heel, but the problem is usually not serious.
Piezogenic pedal papules
While the occurrence of piezogenic pedal papules is fairly common in the United States and around the world, they are often misdiagnosed or treated improperly. As they are not typically painful, many go unnoticed before they are diagnosed. They are also commonly under-reported and may be a hidden cause of plantar fasciitis. To help ensure that your patients receive the right treatment, you should coordinate your care with specialists in various specialties. This will minimize unnecessary testing and treatments and allow you to focus on conservative management.
Piezogenic pedal papules are small, flesh-colored papules that appear on the heel after weight bearing and disappear after weight-bearing is ceased. They can be either bilateral or unilateral. Treatment for piezogenic pedal papules is minimal and noninvasive. The condition does not require surgery or anti-inflammatory drugs. It does require a team approach from physicians, physical therapists, and other medical professionals.
Glucocorticoids
Injections of glucocorticoids to relieve pain are commonly used to treat the underlying condition of plantar fasciitis and piezogenic papules. A glucocorticoid and local anesthetic solution is administered at the site of tenderness. Glucocorticoids reduce pain, but the procedure can also lead to heel pad atrophy and rupture of the plantar fascia. Glucocorticoids should be injected to treat the calcaneal origin of the underlying disease rather than the heel.
Glucocorticoids have long been used to treat a variety of illnesses, including chronic rheumatic conditions and acute injuries. However, despite their widespread use in medicine, there are no well-conducted reviews of their beneficial effects for this condition. This is a problem. Despite the potential for beneficial effects, glucocorticoids are still a first-line therapy in cases of musculoskeletal injuries.
Painless herniation of fat through the dermis
Piezogenic papules are soft, skin-colored bumps that form as a result of herniation of subcutaneous fat into the dermis. Usually seen in long-distance runners, these papules also occur in athletes and those who use their hands for sports. In some cases, the skin becomes thick and painful as a result of the herniation of fat through the dermis. These herniations are not hereditary, but often result in a painful and unsightly skin condition.
Piezogenic pedal papules occur in the heel and are a result of herniation of fat through the dermal layer. These papules are often asymptomatic, appearing only under weight-bearing or pressure application. They may also develop on the wrists or lateral borders of the hand. Piezogenic pedal papules are often accompanied by other painful lesions.
Treatment
Treatment for painful piezogenic pedal papules has several options, including surgery and conservative measures. In infants, the papules are well-defined lobules of mature fat in the mid and deep dermis, and they are often encased in collagen around eccrine glands. In adults, piezogenic papules are elicited by pressure on the heel of both palms. The painful papules are often accompanied by other symptoms of plantar fasciitis, and investigation of repetitive activity and occupational practices is recommended.
The diagnosis of piezogenic papules is based on a differential diagnosis. Initially, it was thought to be a herniation of subcutaneous fat into the dermis. Although they are common in the general population, they are often overlooked and misdiagnosed. The differential diagnosis of piezogenic papules should include infantile pedal papules, xanthoma, and tophi.
