| Piezogenic papules | |
| Synonyms: | Painful fat herniation, piezogenic pedal papules |
| Field: | Dermatology |
| Symptoms: | Multiple yellowish to skin-coloured small or large bumps, mostly painless; typically on heels and wrist |
| Causes: | Pressure |
| Risks: | Obesity, flat feet, athletes, figure skaters, long-distance runners |
| Diagnosis: | Appearance |
| Differential: | Juvenile aponeurotic fibroma |
| Treatment: | None |
| Frequency: | Common |
Piezogenic papules are protrusions of fat that form within the subcutaneous tissue of the skin.[1] They are typically found on the heels or wrists.
They present as multiple small or large bumps characteristically on the heels and wrists.[2] Most are asymptomatic and pain is rare, although some may present with pain before the bumps are noticed. They generally occur bilaterally and display a yellowish to skin-color.[3] They may feel soft or firm.[3] [4]
The bumps are caused by pressure.[1] There may be an association with Prader–Willi syndrome, and around a third of individuals with Ehlers–Danlos syndrome may have them.[2] Risk factors include obesity, flat feet, athletics, figure skating, and long-distance running.[3]
Diagnosis is by its appearance.[3] If present in a child it may appear similar to juvenile aponeurotic fibroma.[3]
Generally, no treatment is required.[3] They usually disappear when pressure is relieved; avoidance of prolonged standing, taping foot, compression stockings, heel cups, padding devices.[1]
Piezogenic papules are relatively common; in one small population-based study, the prevalence was found to be 76%.[1] The same study found that it was not unusual to demonstrate the bumps when pressing a person's wrist.[1]
The term was first coined by W. B. Shelley and Rawnsley, who first described them in 1968.[5] [6]