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Warts


A wart is a growth caused by a virus called the human papillomavirus (HPV). The term plantar comes from medical description for the sole of the foot. Any wart on the bottom of the foot can be called a plantar wart, but there are many types of warts which can affect the feet. Common warts are flesh colored or brown, thick and dome shaped, forming on the non-weightbearing surfaces of the foot. Flat warts are typically small, slightly raised lesions, smooth, flat lesions that occur in a line or cluster on the outside of the foot or the ankle. Periungual warts occur around or under the toenails and are difficult to treat and can be painful. Mosaic warts appear large, but are general several smaller warts grouped into a cluster or formed a plaque. They tend to bleed with easily and can be dry, cracked or scaly. Digitate warts are uncommon on the feet, but can be found on the toes. They tend to grow out with multiple fingerlike projections.

 The human papillomavirus penetrates the skin through small breaks in the surface. Excessive moisture can cause small breaks in the skin, which can give the virus an opportunity to penetrate into the skin. Swimming pool, hot tub areas and public changing rooms are common places to pick up the virus. The virus can also be implanted into the foot by a splinter or a piece of glass. The warts are contagious and can spread to other parts of the foot and to other people, especially to those who use the same shower, bath or changing area.Children, individuals who frequent swimming pool areas and public changing rooms and individuals with a weakened immune system are more vulnerable to contracting the virus and developing plantar warts.

Warts have their own blood and nerve supply. Commonly, pinpoint black areas are visible on the warts surface. These black dots are the wart's superficial network of capillaries, but may only be visible after the top layer of callus tissue is removed.

 A common misconception about plantar warts is that they have roots which can grow deep into the tissues and attach to the bone. This is not true. A wart only grows in the top layer of skin and although the wart may extend slightly deeper, as seen in this picture above, this is generally due to the mechanical forces from walking, pushing the wart deeper into the tissue. are flesh colored or brown, thick and dome shaped, forming on the non-weightbearing surfaces of the foot.

Many people will mistake a wart for a corn or callus. This is common as the top layer of the wart is very callused and thick and can appear much like a callus. In the picture to the right, a wart is visible on the bottom of the big toe. There are multiple pinpoint black areas centrally, surrounded by callus tissue. In many cases, it is difficult to distinguish between a wart and callus until the top layer of the callus tissue is removed. Not all warts will have visible pinpoint black areas, which is why it is important to see a podiatrist for evaluation.    

Warts can look and feel like a callus or a corn and many people with warts complain of feeling like they are walking on a pebble in their shoe. Although many people will never experience much pain with warts, in most cases they are painful. In some cases, the warts can be very painful. Some feel like they have a piece of glass stuck in their foot, while others feel sharp pain with every step.

The surrounding area can become red and inflamed after extended periods of walking and pressure on the wart. Some warts can become very large and extremely painful.


Treatments

There are a number of treatments for warts and the treatments range from duct tape to surgery. The type of treatment depends partly on the size, location and number of warts and the patient. When there are multiple warts over the entire sole of the foot, it is recommended to try topical and oral medication before considering surgery. If there is only one wart, surgery many be a reasonable first step. Warts in between the toes or under the nail may require different treatment regimens than warts on the sole of the foot. Many people find that home treatments are the most convenient for their schedule. Others are willing to make weekly visits to the doctor's office for acid treatments, while some people are want to have surgery to remove the warts.


Doctor's Office: There are a range of treatments you doctor may use.


Salicylic Acid: This is one of the most commonly used medications for the treatment of warts. It is popular because it is well tolerated, not painful and results in little scarring. But, eventhough it can be effective, the destructive process is slow and treatment period is long.


Cantharidin: A popular treatment for warts as the precription name Canthacur® (also includes podophyllin and salicylic acid) this tends to be effective and well tolerated. Treatments are usually 1-2 per week after reduction of excess callus tissue. This is not approved by the FDA for the treatment of warts.