Black Heel

The patient is a 17 year-old boy with a 6 month history of a black area on the heel of the right foot.  This began after wearing a new pair of soccer cleats.  He developed a blisters and has believed that this is from "astroturf" embedded in his skin.

O/E: A localized uniformly black area on the heel of the right foot.

Here is the dermatoscopic image.

This is most likely black heel aka "talon noir."  The dermatoscopic photo was taken after paring down the keratin and shows black globules.  I should have applied some peroxide to dissolve the hemoglobin.  Will ask the patient to do so.

Foreign body secondary to astroturf has not been reported, and this looks like black heel.  There are no good dermatoscopic images on PubMed.

Reference:

Black heel, talon noir or calcaneal petechiae?

Urbina F1, León L, Sudy E. Australas J Dermatol. 2008 Aug;49(3):148-51.

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.

Talon Zumba

Abstract: 36 yo woman with brown-black macule on heel

HPI:  A 36 year-old woman presented in a panic with a recently discovered dark-brown to black macule on the heel of her left foot.  It had been brought to her attention by her pedicurist.  The patient had consulted the Internet and found articles about acrolentiginous melanoma which worried her greatly. Anamnesis revealed that she had been Zumba dancing a few days before this was discovered.

O/E: The lesion measured eight mm in diameter and was dark brown to black in color.  Dermoscopy revealed a black color with a parallel ridge pattern.

Clinical Photos:

On the suspicion that this represents hemorrhage into the strateum corneum (a condition, when on the foot, called black heel or talon noir) the lesion was pared down with a # 15 blade and some of the dark pigment was easily debrided leaving a skin colored base centrally and some petechael spots were seen at the periphery.  The patient was asked to debride the area gently with a heel shaver andgiven a return appointment in two weeks.

Talon noir can be a frightening entity for a patient.  Lacking a history, a physician can be fooled, since the parallel ridge pattern seen on dermoscopy is also present in acral melanomas.  History trumps clinical appearance,

Follow-up:
At two weeks out, the area is almost completely resolved, this confirming the diagnosis of talon noir.

Two weeks after initial visit.

 

Reference: 

1. Talon Noir (Primary care Dermatology Society)  This is an excellent reference and there is no need for more.