|Year : 1992 | Volume
| Issue : 4 | Page : 271-272
Painful piezogenic pedal nodules
Sanjay Singh, G Kalla, VK Jain
Source of Support: None, Conflict of Interest: None
A 20-year old obese male patient presented with painful, soft, skin-coloured papules and nodules on medial side of heels. These lesions appeared only when the patient stood upright and disappeared when weight was taken off the feet. The condition was diagnosed as painful piezogenic pedal nodules. Obesity might have accelerated the development of these unusually large lesions.
Keywords: Painful piezogenic pedal nodules
|How to cite this article:|
Singh S, Kalla G, Jain V K. Painful piezogenic pedal nodules. Indian J Dermatol Venereol Leprol 1992;58:271-2
| Introduction|| |
Piezogenic papule is the term used to describe the soft, skin-coloured papule that appears on the side of heel when standing and which disappears when weight is taken off the foot.  Such painless papules occur commonly in healthy individuals and are often not noticed. Painful peizogenic pedal papules form a rare entity,  which was reported by Shelley and Rawnsley.  We report a case.
| Case Report|| |
A 20-year-old male patient presented with papules and nodules on the medial side of heels. The lesions used to appear when he stood upright and disappeared when he sat. They had become painful for past 6 months and the pain brought them to the patient's notice. Pain used to become progressively more severe on prolonged standing or walking. The number and size of the lesions had increased during this period.
There were 22 papules and nodules on the medial side of left heel [Figure - 1] and 17 on the right, giving the surface of the skin a cobble-stone-like appearance.' The lesions were soft, skin-coloured and tender and their diameter ranged between 0.5 and 1.5 cm. On application of pressure to the plantar surface by the examiner the lesions enlarged in size, became firm, and more painful. Similar, though less prominent and nontender, papules appeared on the lateral side of heels when pressure was applied to the soles, and on the soles of the feet on application of bimanual pressure to the sides of the heels. These papules were not seen when the patient was standing.
Patients height was 155 cm. and his weight was 78 Kg. He did not engage in much physical activity. Family history was negative. Radiologic examination revealed no bony abnormality of the feet. He did not permit a biopsy. He was advised to reduce weight, which he could not; and to wear anklets, which gave him partial relief from pain.
| Comments|| |
The term piezogenic papule was introduced by Shelley and Rawnsley  to imply that the pain and papule were due to pressure (piezo= pressure, genic=giving rise to). They hypothesized that the lesions were caused by herniation of fat through connective tissue defects. Histologic confirmation of this hypothesis was first provided by Harman and Matthews  who showed the lesion to be composed of mature adipose tissue encapsulated by thin fibrous capsule protruding into the thinned overlying dermis. Painful lesions show loss of normal compartmentalization of subcutaneous fat by trabeculae which become degenerated and destroyed following necrosis and haemorrhage.  This damage seen histologically has been thought to be the likely cause of pain  If this is correct, the pain should persist even when the foot is lifted because histologic changes do not revert to normal on lifting the foot. Therefore, we suspect the cause of pain to be simply the stimulation of the cutaneous nerves by protrusion of encapsulated adipose tissue into, dermis when the patient is standing.
Painless piezogenic pedal papules were seen in 10 out of 412 individuals;  and in all of 250 individuals (age 1 to 80 years) when their heels were squeezed by holding the ankle with one hand and applying pressure to the plantar surface with the other. sub These lesions represent small peripheral chambers of fat which are part of the structure of the normal heel. 
Painful peizogenic pedal papules have mostly been described in non-obese individuals and the size of individual lesions has been less than 1 cm. ,,,, Obesity must have increased the burden of weight bearing on our patient's heels and this might have accelerated the pathologic process leading to the appearance of large lesions. Reasons for reporting this case are (1) unusually large size of the lesions, (2) paucity of reports of this condition from India.
| References|| |
|1.||Cohen HJ, Plains W, Gibbs RC et al. Painful piezogenic pedal papules. Arch Dermatol 1970; 101:112-3. |
|2.||SchlappnerOLA, Wood MG, Gerstein W, Gross PR. Painful and nonpainful piezogenic pedal papules. Arch Dermatol 1972; 106 : 729-33. |
|3.||Shelley WB, Rawnsley HM. Painful feet due to herniation of fat. JAMA 1968; 205 308-9. |
|4.||Harman RRM, Matthews CNA. Painful piezogenic pedal papules. Br J Dermatol 1974; 90:573-4. |
|5.||Kohn SR, Blasi JM. Piezogenic pedal papules. Arch Dermatol 1972; 106 597-8. |
[Figure - 1]
|This article has been cited by|
||Piezogenic foot nodules in active children | [Piezoqeniczne guzki stóp u aktywnych fizycznie dzieci]
| ||Brzeziński, P. |
| ||Pediatria i Medycyna Rodzinna. 2008; 4(4): 261-264 |