Black heel, talon noir or calcaneal petechiae?

Abstract

We describe a series of six patients with superficial cutaneous haemorrhages of the feet, including a classical case of black heel (talon noir) and other similar cases with diverse clinical presentations that do not match the typical description of that process. The main differences lay in production mechanism, morphology and location. The causes of these 'atypical' lesions were: burns with hot sand, friction against the rough edge of a swimming pool, wearing new shoes, jogging, or pricking a blister with a needle. Clinically, they consisted of isolated or multiple, small, large or linear, brown or black lesions located in areas that did not include the convex part of the heel, in which talon noir usually appears; on the contrary, the lesions affected the back third of the soles, the toes, periungual fold and plantar arch. As the presence of blood in the horny layer was a common final factor in all these cases, a better name for this process would be 'post-traumatic cutaneous intracorneal blood' to describe black heel and its diverse clinical presentations.

Skin Conditions of Baseball, Cricket, and Softball Players

“…5) [120,121]. Hemorrhagic macules appear on the lateral borders of the heel, middle of the foot, soles, or toes.…”

“…Catchers and fielders develop a related condition, tache noir, when a high-speed ball hits the hand (usually the thenar eminence) and ruptures dermal capillaries. Diagnosis of talon/tache noir, although apparent from history and physical examination, is confirmed by observing black discoloration without active bleeding in successive layers of pared stratum corneum [120,121]. The black puncta can be scraped from the skin, mixed with a small amount of water, and dabbed on to an occult blood screening test to detect the presence of blood [31].…”

“…The black puncta can be scraped from the skin, mixed with a small amount of water, and dabbed on to an occult blood screening test to detect the presence of blood [31]. Dermoscopy can help differentiate melanocytic from purpuric lesions, which have red-black homogenous pigmentation bordered by isolated red-black globules [121,122]. Talon and tache noir resolve spontaneously within 2-3 weeks [123].…”

Purpura du sportif

“…Le purpura s'améliore dans les semaines suivant la fin de la saison [10]. Cette entité est à rapprocher de la « paume noire » ou « black palm » observée chez les gymnastes, les golfeurs, les haltérophiles, les joueurs de sports de raquettes et lors de l'escalade en salle ou en montagne [11,12] et égale-ment de la pseudochromhidrose plantaire (ou « talon noir »), responsable d'un piqueté brun du talon par hémorragies intracornées. Ces dernières sont observées dans les sports néces-sitants des mouvements de changements de direction brutaux (football, basket-ball, tennis.…”

“….) (figure 3A et B) [1,4,12]. Ces microhémorragies palmaires et plantaires sont liées aux forces latérales de cisaillement appliquées entre l'épiderme et les sommets de papilles dermiques.…”