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The article reports on a case study associated with piezogenic pedal papules in a marathon runner. A 28-year-old woman was presented to the clinic for an unrelated condition with an incidental finding of multiple discrete, skin-colored, firm, painless papules on both heels visible only upon standing. The papules were present for many years with no new or enlarging papules. She noted that the papules were more pronounced the day after a long training run of greater than 15 miles. No biopsy was obtained, and a diagnosis of piezogenic pedal papules was made. The pain experienced in some cases of piezogenic pedal papules is thought to be caused by ischemia due to the extrusion of fat with its vasculature and associated nerves. The diagnosis of painful piezogenic pedal papules can be challenging. Clinicians may do multiple tests to identify the cause of foot pain in the athlete. Treatments of both painful and painless papules are often unsatisfactory and include surgery, heel cups, compression stockings, and acupuncture.