Plantar Warts: Do I have one and what are they?

Have you noticed a small growth on the under-side of your feet or toes? Has it started to cause some pain when you are walking bare-foot around the house? Chances are, you could have a plantar wart or otherwise known as a ‘Verruca’. Our Senior Podiatrist, Chris Murray regularly see’s patients in our clinics presenting with plantar warts so has written the following information document to help patients identify and treat them early. 

What is a plantar wart?

Plantar warts are growths that appear on the soles (plantar aspect) of the feet. They are commonly encountered on high pressure or weight bearing areas like the heel and across the balls of the feet. Because of their tendency to appear on weight bearing areas they can be painful and debilitating. This can lead to changes in walking style as an avoidance mechanism, which can then create other compensatory gait and musculoskeletal problems. 

What causes a plantar wart?

Plantar warts are caused by the human papilloma virus (HPV) and are quite contagious (spread easily). Means of transmission include direct skin to skin contact as well as coming into contact with a contaminated surface (such as a floor). The virus enters the body through small cuts or breaks in the skin. HPV thrives in warm, moist environments so walking barefoot in gym change rooms and around swimming pools increases the risk of transmission. 

What do warts look like?:

Your podiatrist will be able to easily identify a plantar wart and be able to differentiate between a plantar wart and other common skin lesions (like a corn). After diagnosis the podiatrist will then be able to plan an appropriate treatment pathway. 

Common features of a wart: 

• A flattened (from pressure) hard grainy appearance that can have a thick overlying callous. 
• An irregular ‘cauliflower like’ pattern. 
• Interruption to the normal striations of the skin (skin lines)
• Tiny black pinpoints through the lesion that are small clotted blood vessels (capillaries). 
• Pain on medial and lateral compression (squeeze) as well as on direct pressure and weight bearing. 

Who is at risk of getting a plantar wart?

• Children and adolescents
• People with a compromised immune system
• People who walk barefoot in areas where there is a lot of public barefoot traffic like swimming pools, change rooms, gyms and parks.

How do I reduce the risk of getting a plantar wart?

• Do not walk barefoot in public areas, particularly those that are warm, humid and wet such as swimming pools, change rooms, parks and gardens. 
• Try and maintain good foot hygiene by making sure your feet are clean and dry at all times. 
• Avoid picking at the skin on your feet as this can lead to breaks in the skin barrier.
• Avoid direct contact with warts. If you have touched a wart, make sure you wash your hands and feet thoroughly. 

What are the treatment options for plantar warts? 

1. Over-the-counter non prescription topical preparations from the pharmacy can sometimes be trailed, particularly on small and recent onset plantar warts. These are generally either a low strength salicylic acid (up to 10% is common), or a small liquid nitrogen applicator.
2. Liquid nitrogen/cryotherapy (through a podiatry or GP clinic).
3. For long-standing and stubborn plantar warts that haven’t responded to over-the-counter treatments, a podiatrist may use a strong caustic preparation such as salicylic acid paste (up to 60%). Salicylic acid works in two ways – by chemically destroying wart tissue, and by stimulating the body’s immune response
4. In rare cases where strong salicylic acid has not been effective, another treatment option for patients at FNQ Podiatry & Orthotics is multi- puncture.  This procedure is done under local anaesthetic and involves needling the wart to break up wart tissue and debridement to remove the loosened material.

How long will it take to get rid of the wart?

• When treated with high strength salicylic acid a plantar wart will generally need anywhere from 3-6 treatments. These treatments are spaced a week apart. 
• If treated via multi-puncture, a plantar wart is removed in its entirety during the procedure. A follow up review appointment is arranged to check healing and ensure complete resolution has been achieved.

If you think you may have a Plantar wart and would like to see what your treatment options are please contact FNQ Podiatry & Orthotics and book an appointment to see one of our friendly Podiatrists.