Talon noir

A talon noir, also known as a 'black heel' is a harmless, asymptomatic, trauma-induced darkening normally affecting the posterior or posterolateral aspect of the heel.

This chapter is set out as follows: 

• A talon noir results from repeated trauma or shearing forces typically associated with sports such as basketball, tennis, football, gymnastics, or marching

• It normally affects younger athletic individuals
• It is asymptomatic 

Distribution

• ​Usually the posterior or posterolateral heel, rarely the metatarsals

Morphology

• ​Grouped, punctate, linear, black or blue / black macules and horizontally arranged petechiae

A similar lesion called palmar petechiae or tache noire is the equivalent diagnosis on the palm and typically occurs in athletes engaged in racquet sports, weight lifting, mountain climbing, gymnastics, mogul skiing, or golfing.

• The diagnosis is usually straightforward. If needs be the stratum corneum can be pared with a #15 blade to expose and remove the haemorrhagic material - this is in contrast with melanoma where the pigmentation is deeper and cannot be removed by paring the stratum corneum. Where doubt exists the patient should be referred urgently to Secondary Care (two-week wait)