Piezogenic pedal papules


Are painful or asymptomatic papules of the feet and wrists that result from herniation of fat through the dermis.

They are common, nonhereditary, and usually are not the result of an inherent connective tissue defect.

Found in a large number of asymptomatic people.

Herniation of fat into the dermis causes the papular appearance.

The papules become apparent when an individual stands with full weight on the heels.

Papules resolve when the weight is removed.

The papules usually occur bilaterally.

The papules may be present on the medial, posterior, and lateral aspects of the heels.

Similar papules may appear on the volar wrists when pressure is applied.

The histology reveals fragmentation of dermal elastic tissue and herniation of subcutaneous fat into the dermis.

No hereditary diseases or syndromes are associated.

Reported in some patients with Ehlers-Danlos syndrome.

76% of US population have pedal papules and 86% have wrist lesions.

Occurs in all age groups.

Most patients are asymptomatic, but the papules can be painful in one third of patients.

Occur worldwide.

Incidence of approximately 10-20% in populations studied.

No racial or hereditary predisposition, except in piezogenic papules that arise in association with Ehlers-Danlos syndrome.

More frequent in women than in men.

Occurs in persons of any age, even children.

Seen in 6% of newborns and 40% of infants.

Most cases lesions are asymptomatic and are noticed incidentally.

Lesions persist and no treatment is required.

Painful papules may be noticed because of associated symptoms, and patients may have limitation of occupational or sporting activities.

Lesions may be more common in people who are overweight, people with flat feet, and people who spend significant time on their feet.

More common in women than in men.

Piezogenic pedal papules were seen in 34% of a series of patients with Ehlers Danlos syndrome, resulting from the connective tissue defect.

The condition includes herniated papules of fat, usually compressible, mostly in the lateral heels.

Examination should occur with patients standing with their full weight on the heels.

Papules usually occur bilaterally and may be present on the medial, posterior, and lateral aspects of the heels.

The papules are typically 2 mm in diameter, and resolve when the weight is removed.

Similar papules may arise on the volar wrists when pressure is applied.

No specific cause.

Most cases are believed to be sporadic, but the condition has occurred within families.

Infantile pedal papules are fairly common, nontender, congenital nodules located on the medial plantar aspects of the foot.

They are most common at age 1 year and typically disappear between ages 2 and 3 years.

Infantile pedal papules do not accentuate upon standing.

The histologic finding is herniation of fat through the dermis from poor compartmentalization of fat because of thinner-than-normal fibrous trabeculae in subcutaneous tissue.

The process is not an inflammatory one.

No effective oral or topical medical therapy is available.

The problem is cosmetic for most individuals, and therapy is rarely needed.

Orthotics may benefit symptomatic individuals.

Rest and elevation help with symptoms.

Betamethasone decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing increased capillary permeability..

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