Pieced nodules M79.81

Author: Prof. Dr. med. Peter Altmeyer

Last updated on: 23.04.2021

Synonym(s)

Hand edge nodules due to pressure; Heel nodules pressure-related; Nodules pulled out; Painful piezogenic pedal papules; Piezogenic papules of the feet; Pressure-related hand edge nodules and heel nodules

History
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Rawnsley and Shelley 1968

Definition
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Single or multiple hernias of fatty tissue that bulge out the overlying skin like a calotte. They are mainly found in the medial or lateral area of the heel edges and also the lateral foot edges in obese but also in normal-weight people. Pieced nodules generally have no disease value.

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Occurrence/Epidemiology
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Depending on the examiner, the nodules are found in 25-75% of the examined subjects.

Etiopathogenesis
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Probably insufficient septation of the fatty tissue. Punctured nodules are more frequent in cases of intensive athletic strain on the feet (e.g. in ice hockey players, endurance runners or tennis players) (Bender TW 3rd 2003). Connective tissue disorders such as Ehlers-Danlos syndrome or Prader-Willi syndrome have been linked to the disease (van Straaten EA et al. 1991).

Manifestation
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Men and women are affected about equally often.

Manifestation of the nodules between the ages of 11 and 60 with a peak of frequency between the ages of 20 and 30.

Localization
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Occurs at the medial, dorsal or lateral edge of the foot, about 2 cm above the foot surface.

Clinical features
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Solitary also multiple up to 20 skin-coloured nodules of about 0.3-0.5 cm in size, soft when lying down, clearly increased in consistency when standing. Occasionally (rarely - in this respect the descriptive diagnosis with - "painful"- is incorrect) a pain on exertion is present (due to hernia-like propulsion of the plantar adipose tissue; this can be well visualized by high-frequency ultrasound (Rodríguez-Bandera AI et al. 2015). The disappearance of the nodules after pressure relief, e.g. by lying down, is also a diagnostically significant phenomenon.

Histology
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Defect in the septation of the subcutaneous fatty tissue.

Therapy
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As a rule, no therapy is required. Information about the harmlessness of the findings. In case of functionally disturbing or painful nodules excision with primary wound closure and subcutaneous suture.

Literature
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Bender TW 3rd (2003) Cutaneous manifestations of disease in athletes. Skinmed 2: 34-40
Rodríguez-Bandera AI et al. (2015) Usefulness of High-Frequency Ultrasound in the Diagnosis of Piezo Pedal
Papules. Actas Dermosifiliogr 106:591-593.
Shelley WB, Rawnsley HM (1968) Painful feet due to herniation of fat. JAMA 205: 308-309
Tlougan BE egt al (2011) Skin conditions in figure skaters, ice hockey players and speed skaters: part I - mechanical dermatoses. Sports Med 41:709-719.
of Straaten EA et al. (1991) Piezogenic papules of the feet in healthy children and their possible relation
with connective tissue disorders.Pediatrics Dermatol 8:277-279.