Multiple papules on the heels

A woman in her 60s presented with a three year history of numerous asymptomatic skin-coloured to yellowish, soft round papules on both heels (fig 1). These papules ranged from 3 mm to 8 mm in diameter and gradually increased in size over a two year period and then stabilised. There was no itching, pain, history of trauma or inflammation surrounding the papules, and nothing remarkable in her medical or family history. The patient had previously presented to general practice and surgical outpatient clinics but did not receive a definitive diagnosis. The patient was never overweight, but her daily activities included frequent, prolonged standing and walking. The papules were prominent when pressure was applied to the heels …