Plantar Warts (Verrucae Pedis)
What are Warts
Plantar Warts are lesions which occur on the soles of the feet and hands. They are generally well circumscribed lesions which can occur as a single wart or a cluster. Unlike corns which tend to look quite similar, warts can be easily distinguished as they have no skin lines running through them and are often more painful to squeeze than on direct pressure unlike corns. This is because warts generally contain nerves where as corns generally don't. Warts may also have small black dots in their center which represent the blood vessels within the wart its self. These blood vessels in warts are the reason behind why they bleed so readily when they are scraped or picked at.
The difference between plantar warts on the foot compared to a warts elsewhere on the body, is that plantar warts appear to grow inwards and are often accompanied by areas of localised callus. This "growing inwards" is due in fact to the excess pressure that occurs on the growing lesion forcing it into the surrounding skin, giving it the appearance of growing inwards (ie. the majority of the wart is beneath the skin). This is complicated by the fact that many parts of the bottom of the foot contain thick skin further protecting the wart from treatment and as mentioned often have associated callus.
Warts are caused by a virus known as the human papilloma virus and are considered to be benign tumours. There are approximately 100 types of wart viruses, some more resistant than others and some easier to treat. The wart virus can be picked up in public showers, swimming centers or any other place where people's bare feet are exposed to surfaces. These lesions can occur spontaneously, but many times can be seen in areas of trauma such as areas where blisters have occurred or in an area of a cut. Warts tend to be very contagious so family members with warts should take care to prevent the spread of infections.
Diagnosis should always be done by a professional, especially before attempting to use store bought products to treat your wart.
Warts are generally flat, light yellow or brownish in colour, and have tiny dots inside (tiny caplliaries which may cause the wart to bleed when scraped). A plantar wart may look like a callus but are often rough, and more spongy. One or more can develop at the same time and can grow to up to one inch in size. Some are painless, while others are quite painful. In severe cases, they cause a change in gait (walking) or posture that results in leg or back pain.
Most plantar warts are diagnosed based on their appearance. In some cases, your doctor may scrape a sample of skin cells from the wart and send the sample to a pathologist for microscopic evaluation.
The first thing that anybody should know about treating warts is that there is there is no way to kill a wart. Warts are a virus, and just like the common cold, the body's immune system will take care of it in time. However in the case of warts, if left untreated they may hang around for years. All treatments used on warts aim at disrupting the area so that the immune system will act to eliminate the virus. Treatments for warts should generally be carried out by a professional. Such treatments include:
Chemical cauterization Single warts often take between 6-8 treatments with a wart specific acid such as salicylic acid solutions or monochloracetic acid but may take longer if multiple warts or resistant warts are present. Such treatments can be performed simply by your podiatrists and can be followed up with a series of at home treatments.
Cryotherapy (freezing) or Surgery Is another option that can be performed by most dermatologists and some experienced GPs and is a common way of getting rid of warts but should only be done on areas that are non weight bearing and are better left as a secondary option if chemical cauterisation fails (esp on the soles of the feet). The reasons for this is the high risk of scar tissue, which if on the sole of the foot, may end up being as troublesome as the wart itself. A wart over a bony prominence such as the ball of the foot should never be surgically removed because again if a scar develops it may become more painful that the original wart itself.
Laser therapy Laser surgery is also a popular method for wart removal and can also be performed if required by many dermatologists. The laser beam cauterises the wound as it destroys the skin of the wart, healing is usually quicker than conventional excision (surgery) of a wart, however like all wart treatments, it does not kill the wart virus and relies upon a healthy immune system.
Prescribed Medications For those who have many warts numbering in the dozens if not hundreds, simple acids or surgery will not work due to the large amount of warts that need to be treated.
In these cases a your doctor may prescribe medications such has high doses of Vitamin A or Cimetidine. "Pickling" your feet in a weak solution of formaldehyde may also be prescribed, however the above should only be done under the strict guidance of a trained doctor who can assess for potential complications and contraindication.
Other treatments include:
Boosting the immune system Since warts are a virus it may be recommended to boost the immune system and leaving them to heal spontaneously. However since they are highly contagious, painful and can spread, it is often recommended to keep a close watch of them and seek help if they become unmanageable.
Over the counter medications There are almost as many wart remedies on the market, as there are folk remedies, most of which aren't strong enough to be of benefit. Self-treatment for plantar warts using an over-the-counter preparation is not generally recommended unless under the advice of a practitioner. Podiatrists will generally have stronger topical treatments available, which in conjunction with regular filing back of the wart will eradicate them in most cases.
Folk Remedies There are literally hundreds of cures for warts including an amazing amount of folk remedies as often warts spontaneously disappear themselves and the treatment gets all the credit.
Leave them be
If your wart is not spreading or causing any harm then many people choose not to under go treatment at all. However, if your wart is painful to walk on or you notice that it is spreading it might be worth considering a check up by your podiatrist. Even if you choose not to undergo treatment, but your wart is causing discomfort, then your podiatrist may be able to assist you with simple ways to make life more comfortable such as a basic insole with a simple padding to offload the area and help you walk pain free.
If you have a wart that seems to keep recurring or is painful, it should be assessed to make sure it is not something other than a wart.
- Avoid walking barefoot in public areas where possible.
- Change shoes and socks daily.
- Keep feet clean and dry.
- If you have children, check their feet periodically.
- Avoid direct contact with warts.
- Do not ignore growths on you skin, or any other suspicious changes in your skin you notice.