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Talon noir in Adult
Other Resources UpToDate PubMed

Talon noir in Adult

Contributors: Nicholas Theodosakis MD, PhD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Talon noir, also referred to as calcaneal petechiae, is an asymptomatic discoloration of acral skin that results from intraepidermal hemorrhage caused by shear-force injuries. Talon noir translated from French means black heel. It most aptly describes lesions upon the feet, particularly the heel, but lesions upon the hand or other sites can also occur. Some dermatologists use the same nosology to refer to both processes. Because the condition can be seen in varied locations and for varied reasons, some dermatologists have suggested the term posttraumatic cutaneous intracorneal blood.

Talon noir tends to affect the posterior foot, the heel, the lateral foot, and the palm. Athletic events often produce lateral shearing forces that cause tearing of blood vessels in the papillary dermis. This creates punctate papillary dermal hemorrhages, leading to extravasation of blood into the epidermis and intracorneal retention of hemoglobin. Because of its location in the stratum corneum, it cannot be cleared by phagocytic cells.

Basketball, lacrosse, football, soccer, and cross-country running are frequent causes of talon noir.

The condition is asymptomatic, and because it is painless, the etiological events are often unrecognized. Because of the discoloration and generally rapid acquisition, patients may be concerned that they have an acral melanoma.

Codes

ICD10CM:
S90.30XA – Contusion of unspecified foot, initial encounter

SNOMEDCT:
21143006 – Calcaneal petechiae

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Acral melanoma – If dyspigmentation does not resolve with superficial paring, the concern for melanoma is increased. Lesions suspected of being even a possible melanoma should be pursued with appropriate referral to dermatology and a possible biopsy.
  • Acral nevus – Also a melanocytic process that is readily appreciated on biopsy.
  • Traumatic tattoo – Implantation of exogenous pigmented material, such as graphite or other carbon material, is not Hemoccult positive.
  • Verruca vulgaris – Sometimes dilated and thrombosed capillaries may be seen in the center of the wart, but usually this is very punctate in nature. Disruptions of skin architecture, such as interruption of skin lines, also indicate that a verruca is present.
  • Tinea nigra – A rare fungal infection with an organism that produces its own melanin-based pigment. The fungus is readily seen on biopsy because of this endogenous pigment production.

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:08/12/2020
Last Updated:09/03/2020
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Patient Information for Talon noir in Adult
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Contributors: Medical staff writer

Overview

Talon noir means black heel. It refers to harmless, painless areas of dark discoloration of the skin caused by repeated impacts. It is commonly seen in athletes, but it can occur in anyone who repeatedly hits an area of the body such as the foot or hand.

Who’s At Risk

Anyone who engages in activities with repeated blows to the skin of the hand or foot is at risk to develop talon noir (foot) or tache noir (hand).

Signs & Symptoms

Look for tiny, dark, irregular spots on the feet, heels, and palms where a forceful activity or sport may have caused "microhemorrhage."

Talon noir is not painful or itchy.

Self-Care Guidelines

Talon noir does not need to be treated.

To avoid making talon noir worse, use protective gear, shoes, and gloves.

When to Seek Medical Care

Because talon noir looks like melanoma, your health care provider may want to test your skin to rule out this skin cancer.

Treatments

There are no specific treatments for talon noir.  Your health care provider may recommend better athletic shoes or padded shoe inserts to avoid further damage. Discoloration may clear on its own.
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Talon noir in Adult
A medical illustration showing key findings of Talon noir : Hyperpigmented macule, Palm, Sporting activity, Plantar foot
Clinical image of Talon noir - imageId=2724295. Click to open in gallery.  caption: 'A light brown patch with black and gray peppering on the heel.'
A light brown patch with black and gray peppering on the heel.
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