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Piezogenic papules – what are they and how do they form?

Bumps on my heel – what are they?  Piezogenic paules

Adipose tissue (fat) performs a number of functions in our body.  Adipose tissue can act as a fuel for energy and can act as a reservoir for vitamins, electrolytes, and chemicals needed for future use.  Adipose tissue also has a structural function that shapes our bodies and helps to protect us from injury.  Adipose tissue is what makes the palm of the hand and sole of the foot soft and able to accommodate weight-bearing.  Adipose tissue is found throughout the body and is often contained within other more rigid tissues such as fascia and the dermis of the skin.

When adipose tissue herniates out of these stiffer supporting tissues and becomes obvious to the eye, the term for this condition is called a piezogenic papule.  The term piezo comes from the Latin term piezein, meaning to compress.   In the heel, adipose tissue acts to pad the bottom of the foot.  With weight-bearing, pressure from the floor is applied to the adipose tissue of the bottom of the foot.  As body weight is applied to the foot, adipose tissue is forced out against the skin forming piezogenic papules.

Are piezogenic papules common?

Piezogenic papules are quite common and are found in 10-20% of the general population.  Piezogenic papules have no predilection for male/female or race.  Piezogenic papules are more common in adults but can be found in children.

How are piezogenic papules treated?

Most cases of piezogenic papules do not require treatment.  When treatment is required due to a piezogenic papule rubbing against a shoe, surgery can be used to excise the piezogenic papule.  Surgical success is often limited by the inability to rebuild the fibrous network that holds the fat.  From a conservative standpoint, heel lifts can be used to raise the heel in the shoe, often lifting the heel away from shoe irritation.


Dr. Jeffrey Oster
Jeffrey A. Oster, DPM

Medical Advisor

Updated 12/24/2019

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