Piezogenic Papules

Although they are quite alarming in appearance, piezogenic papules are quite harmless and mostly painless. They are soft  and compressible lumps, often on the back  or the side of the heel  and often,  on both feet.  

Another distinctive feature is that they are not visible when the foot is off the ground

They are caused by small herniations of fatty tissue breaking through tiny tears in the fascia of the heel, which is why they are not  apparent when the foot is lifted from the floor.

 Often the person who has piezogenic papules is young and athletic.  The papules tend to occur more commonly in women than men.

People who have the connective tissue disorder, Ehlers-Danlos syndrome are more susceptible to these papules as are those who stand for long periods of time.  Athletes, especially long distance runners often develop piezogenic papules. They are not age-related nor do they affect any specific ethnic group.. Occasionally, obesity may be a  causative factor.

Piezogenic papules range in size from 2 mm to 2 cm and are usually pain free. Sometimes there is pain present if nerves are herniated through the fascia along with the fatty tissue. These painful papules  are usually a little larger than 2cm and they occur less frequently.  If pain is present it is usually associated with a history of standing for long periods.

Painful Piezogenic papules may require some changes in lifestyle, to reduce the amount of weight bearing exercise and if appropriate, to reduce body weight.  Compression stockings may help by preventing the herniations whilst heel cups or heel taping often relieves pain.

A visit to your podiatrist will guide you towards the best day to day management regime of Piezogenic papules and orthotics may be prescribed to reduce the pressure on the heel.

If the papules are painless, no treatment is necessary.