Patient Education

Plantar Wart (Verruca Plantaris)

Description

One of the most widely accepted (yet still false) myths is that witches have more warts than non-witches. This is simply not the case. There are plenty of otherwise stereotypical broomstick-flying female magic-workers that have very nice skin indeed.

The truth is that you don’t need to be a witch to get warts. And you certainly don’t get warts from flying around on a broomstick (although you may be apt to get splinters in rather tender parts of your anatomy). Warts are actually caused by the human papilloma virus (or HPV for short). This virus can create warts anywhere on the body (and no, witches aren’t more inclined to get them on their nose or chin), although the area of focus for this article is, naturally, the feet. Warts that form on the bottom of the feet (the plantar surface) are called plantar warts. Which is sort of a no- brainer, really.

Warts are contagious, although not extremely so. Skin that has sloughed off of a wart, or blood from a wart will contain the virus, so coming in contact with such bodily detritus may spread the virus to you. Common areas of infection (since the virus tends to like warm, moist environments) are public showers, lockers, and swimming pools. Sharing shoes or socks with another person who has warts can also lead to an outbreak (and is, admit it, a little gross). You can also spread warts from one part of your body to another by touching or scratching at a wart, then touching another body part. The virus then usually enters the skin through small cuts. (And just so you know, muttering “Double, double toil and trouble,” probably won’t cause warts. Unless you do it while standing in a public shower.)

People with sweaty feet tend to create ideal environments for the HPV, and thus may be more susceptible to developing warts. Children, adolescents and the elderly are also more likely to get warts than other groups of people. And some people are actually immune to the virus. They don’t get warts at all, the lucky folks.

Symptoms

Plantar warts are often mistaken for calluses (and vise versa) because they can look similar. Warts are sometimes covered or surrounded by thickened skin, which may make you think you’ve got a callus or corn rather than a wart. However, unlike calluses, warts tend to be painful if you squeeze them from the sides, while calluses tend to be painful when you press on them directly. Warts also often contain little black dots (which, contrary to popular belief, are not wart seeds but clotted blood in small blood vessels). Also unlike calluses, if shaved down, warts tend to exhibit pinpoint bleeding.

Warts are usually fairly well defined, and may look like small grainy or fleshy bumps on the underside of your foot, or might be hard and flat. They may vary somewhat in color, but are usually brown or gray. Because there’s so much pressure on the bottom of your feet, plantar warts may grow up into the skin rather than create a prominent bump on top of it. However, they won’t grow outside of the skin layers and into your bones. The virus is definitely just an epidermis dweller.

Over time, your wart may grow larger and spread, creating mosaic warts (basically a cluster of warts). The more warts you have, the harder they may be to treat. And, the more pain you may experience while standing, walking or running.

Diagnosis

While rare, it’s possible that a growth on your foot may be cancerous. So, even if you think your bump is a benign wart, it’s probably best to get it checked out by your podiatrist. He or she can suggest various treatment methods if it is a wart, and if it’s a malignant growth, you can get treatment started quickly.

Your foot doctor will probably get a history of your warts, asking how long you’ve had them, what you’ve done so far to treat them, whether your warts are causing you any pain, and if you’ve noticed any changes in your warts recently. (Your podiatrist shouldn’t ask how long you’ve been practicing the dark arts, or if you have a good potion for turning a neighbor into a frog. If he or she does, you can probably give ’em a good dope slap.)

In addition to your warty medical history, your podiatrist will also perform a physical examination of your wart, and may shave it down slightly to check for pinpoint bleeding. If the growth is suspicious, he or she will probably take a biopsy of the growth and have it analyzed.

Treatment

It’s entirely possible for warts to clear up on their own, although this may not happen very rapidly (or at all, in some cases). So, you may opt to have your wart removed rather than wait it out. Over-the-counter options are available, although they are often not as effective as treatment by a podiatrist. It can be difficult for these treatments to penetrate the thick skin on the plantar surface of the foot, and it’s kind of hard to avoid destroying healthy tissue along with the wart. If you have diabetes or other problems with your circulation, nerves or immune system, you should not try to treat warts yourself.

Some over-the-counter or other in-home treatment options include:

  • Duct tape – Yes, you may be able to use this ever-useful tool to create fashion accessories, patch things up around the house, and get rid of your warts. Users of this method typically cover their warts in duct tape for six days, then soak the warts in water to soften the skin. After that, they gently rub at the warts with a pumice stone or emery board to remove, or at least reduce the size of the wart. A single treatment probably won’t get rid of your wart, but repeating this process over a couple of months may produce results. It’s a pretty painless option, and given the printed duct tape designs that are now available, this may be the most fashionable method.
  • Salicyclic acid – This method peels off layers of the wart a little bit at a time. You usually apply it twice a day, usually for several weeks, and rub away the wart in between treatments using an emery board or pumice stone. When using this method it’s important that you apply the acid only to the wart, and not to the healthy tissue near the wart.
  • Freezing – Cryotherapy methods are available both over-the-counter and in a doctor’s office. The stuff you can buy in a drug store generally doesn’t get things as cold, although it may be somewhat effective.

If these over-the-counter treatments don’t adequately reduce your wart problem, or if you have diabetes or other issues, your podiatrist can offer further treatments. Unfortunately, many of these methods can be painful, so be sure to discuss all your options with your doctor before deciding on a treatment, particularly for children. Treatments from your podiatrist may include:

  • Freezing – While you can get over-the-counter cryotherapy treatments, your podiatrist has access to liquid nitrogen, that ultra-cold stuff that can freeze a flower so fast that it shatters if you tap it. But don’t worry-your foot doctor won’t shatter your foot or even your wart. Basically, it just kills the tissue in and around the wart. A blister forms and eventually sloughs off, taking the wart with it. The liquid nitrogen freeze is more likely to be effective than over-the-counter freezing options, simply because it’s so darn cold. This method can be painful, so take care before treating children with cryotherapy.
  • Cantharidin – Another way to kill the tissue in the wart is by applying a substance produced by the blister beetle. You may get an uncomfortable blister from this method, but the application of cantharidin itself isn’t likely to be painful.
  • Surgery – Your wart can be excised using sharp instruments or lasers, although this method could result in scarring, is likely to be painful, and may involve a long recovery.
  • Immune system boosts – Your body loves to destroy malevolent viruses, although sometimes it needs a little extra help. There are injections and topical creams available that can stimulate your immune system and help it fight off the virus causing your warts.
  • Anti-viral injections – While antibiotics are not good for warts (since warts are caused by a virus and not by bacteria), your doctor may suggest an anti-viral medication called bleomycin to kill your HPV infection. However, these injections can be quite painful and are not recommended for those who are pregnant or breastfeeding.

Warts do tend to come back rather frequently, so you may find yourself starting your treatment all over again, or trying different treatments over time. Which may make you consider taking up a wand and donning a black pointy hat. Just be aware that, alas, magic is probably not going to be any more effective than any other treatment.