A cases series of Piezogenic pedal papules
A 33-year-old male, amateur marathon runner, presented with similar papules for over a year that gradually increased in number over the past 3 months. Clinically, the number of lesions was less compared to the other cases. He did not accept to have a biopsy, so histopathological analysis was not able to be performed. Intralesional steroid injection was not helpful.\nPiezogenic papules are constituted of herniations of fat tissue into weight-carrying connective tissue of the heels.[] They occur as a result of continuous pressure on the heels, as a result of factors such as excessive weight, jumping, running, or carrying heavy loads. The pain appears to be caused from the continuous contact between the papules and footwear, although some have proposed that neurovascular anoxia in the lesions may also contribute to the pain.[]\nPiezogenic papules are generally observed in healthy individuals, sportsmen and especially among marathon runners.[] It is for this reason it is considered as among the frictional and mechanical dermatoses related to sports and observed among athletes. Of our cases, the third was a marathon runner. Patients with Ehler–Danlos syndrome, Prader Willi syndrome, rheumatic heart disease and rheumatoid arthritis have been reported in the literature.[] There are few cases with heart valve disease concomitant to pedal papules that were identified in the literature. Only two cases related with rheumatic valve disease has currently been reported.[]\nIn the histopathologic findings of piezogenic pedal papules, dermal fibrosis and the herniation of subcutaneous fat tissue from the papillary dermis are observed.[]\nTreatment outcomes are not always satisfactory. Patients successfully treated with compression treatment, intralesional steroid and anesthetic injection[] have been reported in literature. Changes in footwear and orthopedic support are also known to alleviate the pain and symptoms associated with the papules. Surgery options including the excision of the papules as well as a sealing of the existing hernia can also be performed in patients received unsuccessful conservative treatments. The surgery option is more effective than the conservative methods.[] Since our cases did not want to have surgery, a combination of triamcinolone and lidocaine was injected intralesionally into the larger lesions. However, this treatment was not successful in all of the cases.\nIn conclusion, piezogenic pedal papule is a benign pathology that has been identified in the past four decades. It is presumed to be observed more frequently than it has been reported. As observed in our four cases, different associations can be observed in its etiology. It is overlooked by certain physicians, while other physicians that are unfamiliar with the pathology may not be able to diagnose it. There are no accompanying systemic diseases in most cases. It is important to relieve the patients’ concern regarding its process, and to attempt various treatment options in symptomatic individuals.