This is a reasonably common foot pain complaint that brings patients into the office. They are concerned about the “lumps” that are occurring on either or both heels.
They are a pressure induced herniation of the subcutaneous fat through the fascial lining of the heel. Fascia is a covering over soft tissue, underneath the skin, similar in appearance to saran wrap. What happens is that the fat herniates or protrudes through small tears in the fascial lining resulting in nodules or lumps that are seen in the heel area. Diagnosis is made solely on physical examination; there is no lab work or imaging studies that will diagnose piezogenic papules.
These are benign lesions (non-malignant). The image below is a typical presentation of piezogenic papules.
Off weight bearing they can be difficult to see but on weight bearing they become pronounced but rarely painful. Defects in the fascial lining allow the fat to protrude through and press against the skin creating the lumps. These lumps can be seen on the medial (inside), lateral (outside) and posterior aspect of the heel and can occur on either heel or both heels. They have also been diagnosed on the wrist.
The tendency for this condition is more common in young and athletic people. There is no racial or hereditary predisposition. They are seen slightly more in women then men. In the small percent of patients who experience pain from these herniations the patients tend to be obese or those prone to long periods of standing.
The first treatment is reassurance that these “growths” are harmless.
Plastic heel cups- In those individuals where there is some degree of pain or discomfort, plastic heel cups can be very helpful. These are plastic egg shell shaped devices that are placed around the heel. What they basically do is push the fat back into the fascial defect.
4% denatured alcohol injections- Many foot specialist may also recommend one or more injections of 4% denatured alcohol. This is particularly effective if there is a burning component to the pain as the injections sclerose or deaden the nerves that end at the level of the papules. This is the same injection that we use for Morton's neuroma.
Surgical excision- On very rare occasions they have to be excised. This is generally limited to instances where there is nerve tissue embedded in the fat that is protruding through the fascial defect.
see related article....Morton's neuroma
Want more information? CLICK HERE
I've been doing some aggressive research lately (it's how I found your incredible website) and realize now that my symptoms are not consistant with the diagnosis.
Michael D. Ebeling
Tampa, Florida 33624
Thanks for a most interesting website, which has helped a lot.
I usually do my research on the Mayo clinic website. I think your website is the most informative site I have found when researching foot pain.
I thank you for putting together this incredible website.
....I have been told that it is not hard enough to be cut off. Please help, I am not sure what to do now! THANKS FOR A WONDERFUL AND VERY HELPFUL SITE!
You have an unusually clear, informative and well-written website for laypersons. Thank you for that.
Mansfield Ctr, CT
First, I'd like to thank you for all the information that you provide on your website and the opportunity to write to you.
First, I want to let you know that you have the best web site I've found related to foot issues. (The only thing I had difficulty finding was the "ask a question" page.)
I received the orthotics Monday afternoon and began wearing them Tuesday. After two days I would say that I have noticed a huge improvement in the discomfort I have been experiencing. My foot feels better than it has in months.
I greatly admire someone like you who would donate and dedicate so much time and effort to helping strangers with no compensation. Truly, it is uncommonly kind. And your site is so intelligently arranged.
Pacific Grove, CA
I used to work for a podiatrist (front desk) back during summers in
college years ago, so I know the benefits of good care. Again, I want
to thank you for an EXCELLENT website. It was so great to get to your
site (top of google search) and actually find all the answers I needed
EASILY and QUICKLY! Clearly you put a ton of work into it and I really
All the best,
By the way, millions of websites could use yours as a guideline on how to organize information and make the site user-friendly. Kudos to you!
Thank you for your very interesting and informative site!
By Marc Mitnick DPM (C)2006-2018, foot-pain-explained.com LLC
Solo Build It!