Black Heel Associated with Intraepidermal Hemorrhage

 

Synonyms: calcaneal petechiae/purpura, talon noir

 

Mechanism: Hemorrhage into the stratum corneum, within the epidermis and/or in the papillary dermis.

 

The change in skin color often appears suddenly. It may be hard to discern in a person with dark skin.

 

Risk factors:

(1) sports with sudden stopping or starting

(2) socks and shoes that allow superficial shear injury (risk reduced with antishearing insoles or felt placed in the shoe)

(3) playing on a hard surface

 

Sports associated with shear injuries:

(1) tennis

(2) handball

(3) racketball

(4) basketball

 

Shavings from the skin will test positive for occult blood using a guiac test.

 

The lesion should resolve in a few weeks with foot rest.

 

Differential diagnosis:

(1) malignant melanoma

(2) deeper hematoma