If the condition is painful, patients may report limitation of occupational or sporting activities. Piezogenic papules may be more common in people who are overweight, people with flat feet, and people who spend significant time on their feet. Examine patients standing with their full weight on the heels. Papules may be present on the medial, posterior, and lateral aspects of the heels. They usually occur bilaterally.
Papules resolve when the weight is removed.
Similar papules may arise on the volar wrists when pressure is applied. No specific causes are attributed to the herniation. The condition has occurred within families, but most cases are believed to be sporadic. Piezogenic papules may be more common in people who are overweight, as well as in individuals with orthopedic problems including flat feet. However, they also can occur in newborns with no clear predisposition.