The papules become apparent when an individual stands with full weight on the heels, and they resolve when the weight is removed. The papules, which usually occur bilaterally, may be present on the medial, posterior, and lateral aspects of the heels. Similar papules arise on the volar wrists when pressure is applied. The histology is similar in both wrist and heel papules, revealing fragmentation of dermal elastic tissue and herniation of subcutaneous fat into the dermis. These occur in all age groups.
Most patients are asymptomatic, although the papules can be painful.
Painful papules are less common and may correlate with EDS, obesity, and occupational or sporting exposure. Painful papules can limit participation in sports and may affect occupational activity. Pedal papules in the newborn, which are present at birth, are different than adult piezogenic papules. They are solitary, occur in the medial plantar foot, and lack a piezogenic factor. In most cases, lesions are asymptomatic and are noticed incidentally by affected individuals.