Black Heel

 

 

(Calcaneal Petechiae)

 

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. Black heel was first described in a group of basketball players in 1961.¹ 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, and mountain climbers.

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%.² This sports-related dermatosis probably is much more common than has been reported.

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.

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

Black heel (calcaneal petechiae) occurs in adolescents and young adults who participate in sports that involve frequent starts and stops, such as basketball, football, soccer, lacrosse, and racquet sports. Additionally, constant pounding on hard surfaces causes injury of the heel against the back of the shoe in runners.³

• Patients present with an irregular dark macule over the heel .
• The lesion usually is asymptomatic and does not inhibit the patient from performing routine daily activities.
• The patient may or may not relate the onset of the lesions to participation in sports.

Examination reveals a blue-to-black macule or patch ranging in size from a few millimeters to several centimeters in diameter.

• The posterior and posterolateral heel are affected most commonly.
• On close inspection, multiple petechiae are centrally aggregated with a few scattered satellite macules.
• The dyschromia often is in a horizontal distribution; however, both circular and oval lesions may occur.

Treatment

Treatment is not necessary for black heel (calcaneal petechiae) because the lesion resolves spontaneously with discontinuation of the causative activity. The placement of a felt pad in the heel of the shoe may be curative.

Skin lubrication, heel cups, a change of footwear, wearing 2 pairs of thick socks, and a break from training may reduce the incidence of black heel (calcaneal petechiae).

Paring down the black heel (calcaneal petechiae) lesion with a scalpel blade may result in a complete clearing of the dyschromia.

Sports participation can be continued without harm to the patient, although the black heel (calcaneal petechiae) will persist unless padding is added to the heel of the athletic shoe

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