Rheumatoid nodules develop at pressure points on the feet and may be painful. Granuloma annulare produces multiple flesh-colored papules that may occur on the feet and elsewhere. They are typically not symptomatic, and prolonged standing or walking does not change their size. Warts of the feet are often multiple and may be symptomatic. The surfaces of warts are verrucous, however, and do not change size quickly.
Piezogenic papules is the correct diagnosis.
They indicate small herniations of fat through tears in the connective tissue trabeculae and are exacerbated by hydrostatic pressure from prolonged standing or walking. This patient chose not to treat the condition. In highly symptomatic cases, heel cups or foam rubber pads placed in the shoes can minimize the pain. Diagnostic pearl Consider piezogenic papules if lesions on the feet suddenly enlarge after prolonged standing or walking.