Mechanical and Friction-Induced Dermatoses in Athletes: Black Heel, Piezogenic Papules, and Related Traumatic Skin Conditions - a narrative review
DOI:
https://doi.org/10.12775/QS.2026.77.76170Keywords
sports dermatology, talon noir, piezogenic pedal papules, friction blister, acral melanoma, connective tissue disorders, foot dermatoses, athletesAbstract
Background. Repetitive mechanical loading, shear, and friction in sport produce a recognisable spectrum of cutaneous injuries frequently mistaken for infectious, neoplastic, or systemic disease. Black heel (talon noir), piezogenic pedal papules, blisters, calluses, corns, jogger's toe, and subungual haematoma are common but underreported, and their mimicry of acral melanoma creates diagnostic risk.
Aim. To synthesise the epidemiology, pathophysiology, diagnostic pitfalls, and management of mechanical and friction-induced dermatoses in athletes, with emphasis on black heel and piezogenic papules.
Materials and Methods. This narrative review draws on peer-reviewed epidemiological surveys, hospital and sports-cohort case series, dermatological case reports, a paediatric scoping review, biomechanical and finite-element modelling studies, and consensus reviews of sports dermatology, connective tissue disease, and skin barrier physiology.
Results. Friction-related lesions cluster on the feet, hands, and trunk and are associated with running distance, footwear, surface, and training volume. Talon noir and piezogenic papules are usually benign and self-limited, but can mimic acral lentiginous melanoma or signal connective tissue disorders such as Ehlers-Danlos syndrome, GATA2 deficiency, or joint hypermobility, particularly when lesions are painful, atypical, or occur outside the expected age or activity context. Diagnostic accuracy improves with dermoscopy, scraping tests, and attention to bilateral distribution and exertion history. Management is predominantly conservative, though intralesional therapies exist for refractory painful piezogenic papules.
Conclusions. Awareness of the mechanical aetiology and differential diagnosis of these dermatoses can reduce unnecessary biopsies and psychological burden while ensuring that rare but important systemic associations are not overlooked.
References
1. Helm MF, Helm TN, Bergfeld WF. Skin problems in the long-distance runner 2500 years after the Battle of Marathon. Int J Dermatol 2012;51:263–70. (Cited via: Partyka A, Wierzejska N, Nowak A, Fugas A, Smykiewicz K, Dobrzańska J, Pach M, Chmielowiec Z, Dziedzic M, Michalczewska A. Running the risk - examining dermatologic concerns and skin neoplasms in runners. Qual Sport. 2024;18:50901.) DOI: https://doi.org/10.12775/qs.2024.18.001
2. Szot A, Kmak BE, Górska M. The most common dermatoses of athletes. J Educ Health Sport. 2024;67:54887. DOI: https://doi.org/10.12775/jehs.2024.67.54887
3. Purim KSM, Leite N. Sports-related dermatoses among road runners in southern brazil. An Bras Dermatol. 2014;89(4):587–592. DOI: https://doi.org/10.1590/abd1806-4841.20142792
4. Choudhury S, Mandal A. Talon noir: a case report and literature review. Cureus. 2023. DOI: https://doi.org/10.7759/cureus.35905
5. Feci L, Fimiani M, Rubegni P. Parallel-ridge pattern on dermatoscopy: observation in a case of purpura traumatica pedis. Dermatol Pract Concept. 2015;27–29. DOI: https://doi.org/10.5826/dpc.0504a07
6. Altin C, Askin U, Gezmis E, Muderrisoglu H. Piezogenic pedal papules with mitral valve prolapse. Indian J Dermatol. 2016;61(2):234. DOI: https://doi.org/10.4103/0019-5154.177803
7. Belkız U, Ali ÖM, Mehmet GZ, Yunus Ö, Müge AE. Muscle herniation of the extremities coexistent with piezogenic pedal papules. Indian Journal of Dermatology. 2022;67(4):420–421. DOI: https://doi.org/10.4103/ijd.ijd_952_21
8. De D, Singh S, Khullar G. Piezogenic pedal tumors of obesity: unusual presentation of an innocuous dermatosis. Indian Dermatol Online J. 2017;8(1):56. DOI: https://doi.org/10.4103/2229-5178.198757
9. Edimo CO, Wajsberg JR, Wong S, Nahmias ZP, Riley BA. The dermatological aspects of hEDS in women. International Journal of Women's Dermatology. 2021;7(3):285–289. DOI: https://doi.org/10.1016/j.ijwd.2021.01.020
10. Amarnani AA, Poladian KR, Marciano BE, Daub JR, Williams SG, Livinski AA, Hsu AP, Palmer CL, Kenney CM, Avila DN, Holland SM, Katz JD. A panoply of rheumatological manifestations in patients with GATA2 deficiency. Sci Rep. 2020;10(1):8305. DOI: https://doi.org/10.1038/s41598-020-64852-1
11. Pochcial P, Solomon SC, Bruno KA, Fairweather D, Kinane A, Letzkus L, Gurka KK, Stephens I, Knight DRT. Age-related symptom clustering in pediatric hypermobility spectrum disorders: a scoping review. Orphanet J Rare Dis. 2026;21(1):264. DOI: https://doi.org/10.1186/s13023-026-04424-0
12. Kang EH, Wilson DG, Petric JK, Ulman S. Strategy to step on obstacle during cross-country race to minimize overuse injury risk. PLoS One. 2026;21(6):e0335121. DOI: https://doi.org/10.1371/journal.pone.0335121
13. Cohen PR. A unique acquired athletic dermatologic condition in a half marathon participant: an autobiographical case report of sports-associated clothing related axillary tangled clumped hairs (SCRATCH). Cureus. 2025. DOI: https://doi.org/10.7759/cureus.85161
14. Alzoabi NM, Algamdi BNM, Alqahtani J, Aljalfan AAN, Aljuhani TS, Alotaibi HK, Alzawad AA, Alsinan SM, Alawadh RM, Alasbly DR, AlMohrij SS, Rubaian NFB. Exercise-related skin complaints of saudi gym users in the eastern province of saudi arabia: a cross-sectional study. Journal of Family and Community Medicine. 2025;32(4):347–353. DOI: https://doi.org/10.4103/jfcm.jfcm_189_25
15. Turkmani MG. Piezogenic pedal papules treated successfully with deoxycholic acid injection. JAAD Case Reports. 2018;4(6):582–583. DOI: https://doi.org/10.1016/j.jdcr.2018.03.027
16. Karadag A, Bilgili S, Guner S, Yilmaz D. A cases series of piezogenic pedal papules. Indian Dermatol Online J. 2013;4(4):369. DOI: https://doi.org/10.4103/2229-5178.120647
17. Schubert-Hjalmarsson E, Söderpalm AC. Diagnostic value of piezogenic papules in childhood: a scoping review and analysis of existing data. BMC Pediatr. 2026;26(1):734. DOI: https://doi.org/10.1186/s12887-026-07414-0
18. Rocha BDO, Fernandes JD, Prates FVDO. Piezogenic pedal papules. An Bras Dermatol. 2015;90(6):928–929. DOI: https://doi.org/10.1590/abd1806-4841.20154884
19. Soumiya I, Manogna P, Logamoorthy R, Karthikeyan K. Olympic and board game dermatology: exploring eponyms linking skin conditions to sports and strategy games. Indian Dermatology Online Journal. 2025;16(2):342–345. DOI: https://doi.org/10.4103/idoj.idoj_852_24
20. Kaliciak I, Korda O. Skin barrier dysfunction in endurance athletes: a narrative review of mechanisms, environmental stressors, and clinical implications. Qual Sport. 2026;63:73304. DOI: https://doi.org/10.12775/qs.2026.63.73304
21. Feldman ECH, Hivick DP, Slepian PM, Tran ST, Chopra P, Greenley RN. Pain symptomatology and management in pediatric Ehlers–Danlos syndrome: a review. Children. 2020;7(9):146. DOI: https://doi.org/10.3390/children7090146
22. Campanelli V, Piscitelli F, Verardi L, Maillard P, Sbarbati A. Lower extremity overuse conditions affecting figure skaters during daily training. Orthopaedic Journal of Sports Medicine. 2015;3(7):2325967115596517. DOI: https://doi.org/10.1177/2325967115596517
23. Zügel M, Maganaris CN, Wilke J, Jurkat-Rott K, Klingler W, Wearing SC, Findley T, Barbe MF, Steinacker JM, Vleeming A, Bloch W, Schleip R, Hodges PW. Fascial tissue research in sports medicine: from molecules to tissue adaptation, injury and diagnostics: consensus statement. Br J Sports Med. 2018;52(23):1497–1497. DOI: https://doi.org/10.1136/bjsports-2018-099308
24. Abate M, Gravare-Silbernagel K, Siljeholm C, Di Iorio A, De Amicis D, Salini V, Werner S, Paganelli R. Pathogenesis of tendinopathies: inflammation or degeneration? Arthritis Res Ther. 2009;11(3):235. DOI: https://doi.org/10.1186/ar2723
25. Mach N, Fuster-Botella D. Endurance exercise and gut microbiota: a review. Journal of Sport and Health Science. 2017;6(2):179–197. DOI: https://doi.org/10.1016/j.jshs.2016.05.001
26. Pournot H, Bieuzen F, Louis J, Fillard JR, Barbiche E, Hausswirth C. Time-course of changes in inflammatory response after whole-body cryotherapy multi exposures following severe exercise. PLoS ONE. 2011;6(7):e22748. DOI: https://doi.org/10.1371/journal.pone.0022748
27. Lombardi G, Ziemann E, Banfi G. Whole-body cryotherapy in athletes: from therapy to stimulation. An updated review of the literature. Front Physiol. 2017;8:258. DOI: https://doi.org/10.3389/fphys.2017.00258
28. Alowirdi F, Altawil L, Alhumidi A, Alzain M. Asymptomatic plantar nodules in a 1-year-old healthy girl. JAAD Case Reports. 2020;6(11):1179–1181. DOI: https://doi.org/10.1016/j.jdcr.2020.09.008
29. Whittington CP, Kalsi S, Shea KE, Morley KW. Asymptomatic plantar nodules in a toddler. Cureus. 2022. DOI: https://doi.org/10.7759/cureus.30611
30. Jin H, Wang W, Zhang G, Chen S, Tong Y, Lu D, Li J, He L, Tang X. Advances in flexible wearable pressure/strain sensors for motion monitoring in orthopaedic sports medicine. Journal of Orthopaedic Translation. 2026;57:101084. DOI: https://doi.org/10.1016/j.jot.2026.101084
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