Talon noir in Adult
Alerts and Notices
Synopsis
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
Subscription Required
Diagnostic Pearls
Subscription Required
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
Subscription Required
Management Pearls
Subscription Required
Therapy
Subscription Required
References
Subscription Required
Last Reviewed:08/12/2020
Last Updated:09/03/2020
Last Updated:09/03/2020
Patient Information for Talon noir in Adult
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.Talon noir in Adult