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May 1970


Author Affiliations

751 King St West Kitchener, Ontario, Canada

Arch Dermatol. 1970;101(5):619. doi:10.1001/archderm.1970.04000050123022

To the Editor.—  Cohen et al1 describe painful papules of the sides of the heel. They quote Shelley and Rawnsley2 as considering these papules to be due to fat herniation through connective tissue defects. Unfortunately, they were unable to obtain consent to biopsy these lesions for confirmation of the clinical impression.My only experience with this problem was a 22-year-old white woman who had similar lesions of the heel, for a two-month duration.A biopsy was performed which revealed an intact epidermis showing moderate keratosis and a prominent granular cell layer. The pattern of rete ridges was poorly developed. There was nonspecific degeneration of collagen with hyalinization and blurring of architectural detail. Sweat glands and ducts could be readily identified although they were not numerous. There was no appreciable inflammatory response. Special stains for amyloid were negative.The concept of fat herniation on pressure would appear to be

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