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Black Heel (Calcaneal Petechiae)

Black Heel (Calcaneal Petechiae)

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Black heel (calcaneal petechiae) is a self-limited, asymptomatic, trauma-induced darkening of the posterior or posterolateral aspect of the heel that occurs primarily in young adult athletes. [1] Black heel was first described in a group of basketball players in 1961. [2]

Although clinically insignificant, black heel is important because of its close clinical resemblance to melanoma.

A similar lesion termed black palm (tache noir) has been described on the thenar eminence in weightlifters, gymnasts, golfers, tennis players, mountain climbers, and baseball players. [3] Superficial cutaneous hemorrhages of other areas of the feet have been published in the literature. [4, 5]

Black heel (calcaneal petechiae) is caused by a repeated lateral shearing force of the epidermis sliding over the rete pegs of the papillary dermis. This damages the delicate papillary dermal capillaries, resulting in intraepidermal hemorrhage.

The exact incidence of black heel (calcaneal petechiae) is unknown. One study involving 596 19-year-old sports participants revealed an incidence of 2.9%. [6] This sports-related dermatosis probably is much more common than has been reported.

Black heel (calcaneal petechiae) primarily occurs in young adult athletes, but it may appear in persons of any age if the appropriate conditions occur.

Prognosis for black heel (calcaneal petechiae) is excellent. Complete clearing is achieved with cessation of the causative activity usually within 2-3 weeks of rest. The lesion of black heel (calcaneal petechiae) usually is asymptomatic, although both pain and tenderness can occur. The black areas always resolve spontaneously if the traumatic inciting events are discontinued.

Tlougan BE, Mancini AJ, Mandell JA, Cohen DE, Sanchez MR. Skin conditions in figure skaters, ice-hockey players and speed skaters: part I – mechanical dermatoses. Sports Med. 2011 Sep 1. 41(9):709-19. [Medline].

Crissey JT, Peachy JC. Calcaneal petechiae. Arch Dermatol. 1961 Mar. 83:501. [Medline].

Lao M, Weissler A, Siegfried E. Talon noir. J Pediatr. 2013 Sep. 163(3):919. [Medline].

Urbina F, León L, Sudy E. Black heel, talon noir or calcaneal petechiae?. Australas J Dermatol. 2008 Aug. 49(3):148-51. [Medline].

Sardana K, Sagar V. Black heel (talon noir) associated with a viral exanthem. Indian Pediatr. 2013 Oct. 50(10):982. [Medline].

Rufli T. Hyperkeratosis haemorrhagica. Hautarzt. 1980 Nov. 31(11):606-9. [Medline].

Mailler-Savage EA, Adams BB. Skin manifestations of running. J Am Acad Dermatol. 2006 Aug. 55(2):290-301. [Medline].

Akasu R, Sugiyama H, Araki M, Ohtake N, Furue M, Tamaki K. Dermatoscopic and videomicroscopic features of melanocytic plantar nevi. Am J Dermatopathol. 1996 Feb. 18(1):10-8. [Medline].

Saida T, Oguchi S, Ishihara Y. In vivo observation of magnified features of pigmented lesions on volar skin using video macroscope. Usefulness of epiluminescence techniques in clinical diagnosis. Arch Dermatol. 1995 Mar. 131(3):298-304. [Medline].

Malvehy J, Puig S, Braun RP, Marghoob AA, Kopf AW. Handbook of Dermoscopy. United Kingdom: Informa UK Ltd; 2006. 70.

Elder DE. Lever’s Histopathology of the Skin. 9th ed. Lippincott Williams & Wilkins; 2005. 367.

Hafner J, Haenseler E, Ossent P, Burg G, Panizzon RG. Benzidine stain for the histochemical detection of hemoglobin in splinter hemorrhage (subungual hematoma) and black heel. Am J Dermatopathol. 1995 Aug. 17(4):362-7. [Medline].

Weedon D. Skin Pathology. 2nd ed. Elsevier Limited; 2002. 595.

Christine Malcolm, MD, FRCPC Resident Physician in Dermatology, Department of Internal Medicine, University of Toronto Faculty of Medicine

Disclosure: Nothing to disclose.

Scott Richard Albert Walsh, MD, PhD Assistant Professor, Program Director, Department of Dermatology, University of Toronto, Sunnybrook Health Sciences Centre

Scott Richard Albert Walsh, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, International Society of Dermatology, Society for Investigative Dermatology, Canadian Dermatology Association

Disclosure: Nothing to disclose.

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society for MOHS Surgery, Association of Military Dermatologists, Phi Beta Kappa

Disclosure: Nothing to disclose.

Edward F Chan, MD Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Donald Belsito, MD Professor of Clinical Dermatology, Department of Dermatology, Columbia University Medical Center

Donald Belsito, MD is a member of the following medical societies: New York County Medical Society, Noah Worcester Dermatological Society, Phi Beta Kappa, American Contact Dermatitis Society, Dermatology Foundation, Dermatologic Society of Greater New York, Alpha Omega Alpha, American Academy of Dermatology

Disclosure: Nothing to disclose.

Joel G DeKoven, MD, MHSc, FRCPC Associate Professor, Division of Dermatology, Department of Medicine, University of Toronto Faculty of Medicine, Sunnybrook Health Sciences Centre and St Michael’s Hospital, Canada

Joel G DeKoven, MD, MHSc, FRCPC is a member of the following medical societies: American Academy of Dermatology, American Contact Dermatitis Society, Canadian Dermatology Association, Canadian Medical Association, Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Jonathan Baron, MD Consulting Staff, Dermatology Group

Jonathan Baron is a member of the following medical societies: American Medical Association and Arizona Medical Association

Disclosure: Nothing to disclose.

Norman Levine, MD Professor, Department of Medicine, Section of Dermatology, University of Arizona Health Sciences Center

Disclosure: Nothing to disclose.

Black Heel (Calcaneal Petechiae)

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