What are Plantar Warts?
Warts are a growth on the skin that is caused by a viral infection from the Human Papilloma Virus (HPV). There are over 100 differentstrains of HPV, but only a few cause warts on your feet. The others are more likely to cause warts on other areas of your skin &body eg. hands, face or genitals.A wart that you find on the sole of your foot is officially called a verruca wart or plantarwart.
Although they're not related to pressure and can be found anywhere on the feet, you'll often find them on your heels or otherweight-bearing areas.
Plantar warts are not usually a serious concern for your health, however due to their contagious nature and if they are causing you pain anddiscomfort, we recommend seeking advice and a treatment plan from our podiatrists in Brisbane.
Causes & risk factors
HPV is a slow-growing virus that is transmitted by direct or indirect contact. This means you could get it directly from someone who has thevirus (e.g. skin to skin contact), or by sharing floor surfaces, shoes or socks with someone infected. However, not everyone that comes incontact with the virus will develop warts, as each person's immune system responds differently to the viral strains.
The virus thrives in warm, moist environments, so is commonly picked up from communal areas such as public showers and pools, entering yourbody through a cut or a break in the skin.
This virus attacks the skin on the bottom of your feet, causing the top layer of skin to grow rapidly and form a fleshy raisedlesion.
Anyone can get a plantar wart. Nonetheless there are a number of factors that can increase your risk of getting a foot wart, including;
- Children & teenagers. They are more common in children & teenagers, due to increased exposure from publicspaces e.g. school pools, and they are still building immunity to viruses.
- Weakened immune system
- Walking barefoot in communal areas especially where the virus thrives e.g. locker rooms & showers.
- Cuts, injuries or skin infections on your feet that become a portal of entry for the virus
- Having direct contact with someone with warts
Symptoms
Plantar warts can present at all shapes and sizes. As it is a viral infection, tiny blood vessels grow at the core of the wart. Thesetiny vessels supply it with blood and nutrients, and often appear as little dark spots in the centre of the wart. It is common toexperience pain from a plantar wart, particularly if it is on weight-bearing area of your foot. The pressure that your body weightplaces on the wart is what makes it uncomfortable.
Some common symptoms you may experience if you have a plantar wart:
- A small, rough, grainy lesion that is growing on the sole of the foot (usually on the toes, the ball of the foot or the heel region).
- The fleshy lesion has a solid border.
- Black dark spots in the lesion.
- Can have overlying hard skin with a yellowish appearance.
- Pain when squeezing the outside margins of the lesion.
- Pain when walking if it's on a weight-bearing area of the foot.
- A lesion that disrupts the normal skin lines and patterns on your foot
- There may be multiple lesions in a similar location. This is called a mosaicwart.
Diagnosis
If you experience some or all of the symptoms above, you may be able to diagnose yourself with a simple test. It can be done using TheSqueeze Test.This can help to identify whether you have a wart or a corn.
The Squeeze Test
Simply squeeze the area from either side — if this elicits pain, it is more likely a wart versus a corn.
To ensure you get an accurate diagnosis, we recommend seeing one of our podiatrists, as the treatment for a wart is very different tothe treatment for a corn. Yourpodiatrist can usually tell if your skin growth is a wart just by looking at it, but if it is still not clear, a sample may be takento be analysed and confirmed.
Treatment
Generally, warts will go away on their own, but plantar warts often require active treatment and removal because they can be very painfulbased on their location on the sole of the foot. Some warts go away after a few treatments whereas long standing warts can take severalmonths to be fully resolved.
Podiatrist’s can help in a number of ways, including:
- Use Swift Therapy, medical microwave technology that ishighly effective in resolving warts.
- Sharp debridement to remove the hard outer layer of the wart tissue
- Use of mild acids to burn away the wart tissue
- Use of cryotherapy to freeze the wart
- Minor surgery done under local anaesthetic for complete plantar wart removal
Swift Therapy
SWIFT uses medical microwave technology that is highly effective in resolving warts and verrucae.
The machine allows us to deliver a focused microwave signal into the skin, ensuring only the wart is treated. It rapidly heats wart tissueto 42-45ºC. This sudden increase in temperature can cause discomfort, however, as SWIFT treatments are very quick, discomfort only lasts afew seconds. Once the appropriate dosage has been delivered, you can walk out without dressings and in no pain. For most people, thewarts will not require sharp debridement before using SWIFT.
This technology has between a 75-83%success rate,which is higher than any other treatment currently on the market.
Find out more about SWIFT Therapy.
In clinic chemical treatments
There are two main topical chemicals used in clinics to treat your warts.
1. Silver Nitrate
- Most gentle chemical application
- The podiatrist would debride away wart tissue to expose blood supply and then apply silver nitrate to the wart tissue.
- The debridement and chemical application cause tissue trauma in attempt to kick start the body’s immune system into action.
- Silver nitrate can cause a grey staining of the skin which will eventually wear off.
2. Salicylic Acid
- This chemical is typically formulated into a paste-like substance, which is applied to the lesion after debridement.
- Similarly, to silver nitrate, the chemical reacts with the skin creating tissue trauma in attempt to activate the body’s immuneresponse.
Depending on the size of the wart and how long the infection has been present, you may require several treatments. We recommend thesechemicals are applied every 1-2 weeks until resolved. In some cases, we may encourage you to apply an over-the-counter treatment in additionto these chemical treatments throughout your treatment period.
Cryotherapy
Cryotherapy is the technique where a freezing agent (usually liquid nitrogen) is applied directly to the wart. It's a very quick treatmentbut the freezing sensation can cause discomfort and a blister may form after, which will resolve in the days following the treatment.
It may be tender to walk on following the procedure but in most cases you require less treatments using this method versus the chemicaltreatments.
This treatment is usually repeated 2-4 weeks apart until resolved.
Surgical plantar wart removal
Curettage is a surgical procedure where the area around the wart is numbed by a local anaesthetic. The podiatrist then removes the warttissue to expose healthy skin. Phenol chemical is then used to burn the wart tissue and silver nitrate is used to stem the bleeding.
During the first few days post surgery, you will need to stay off the foot as much as possible, as it will be tender with weight bearing.Within 1-2 weeks most people are walking normally and pain is significantly reduced/resolved.
Thesuccess rate of this treatment is estimated between 65-85%.
At home treatment options
Over-the-counter
There are many brands of over-the-counter products e.g. WartOffor Wartner. These over the counter remedies usually contain either;a mild concentration of salicylic acid or are a home freezing kit. If we were to recommend an at home treatment, we would suggest tryingthe wart off stick. Apply for 4 weeksfollowing the directions on the packet and if this does not resolve the issue, contact our podiatrists for an appointment.
Home remedies
- Duct tape to suffocate the wart
- Apple cider vinegar
- Garlic
Although you may know people who have had success with these remedies. It is important to remember that to successfully treat a wart, weneed to stimulate an immune system response to combat the virus. These at home remedies have little to no evidence for success andcan cause skin irritation and/or infection.
What can happen if I ignore a plantar wart?
In 65% of cases, warts will clear up on their own and without medical intervention. However, if you ignore a severe plantar wart or a mosaicwart, the following could happen:
- Prolonged pain and discomfort, resulting in more serious treatment down the track.
- Changes in posture or normal gait if a painful wart is changing how you stand, walk or run and is causingmuscle or joint discomfort.
- The virus could spread to other parts of the body, causing more warts to develop.
- You could pass on the virus to other people, including friends and family.
Prevention
Here are a few tips to prevent warts from occurring in the first place:
- Avoid walking barefoot in communal areas
- Keep your socks and shoes clean
- Keep your feet clean and dry
- Avoid having direct contact with people with existing wart
