Plantar Warts

The common wart is known as verruca vulgaris. They are caused by a viral infection of the skin. This occurs as a result of direct contact with the virus. The warts are contagious and can spread to other parts of the body and to other family members. They do not spread through the blood stream. They occur more commonly in children than adults. When they occur on the bottom of the foot, they are called plantar warts. This name is derived from the location of the foot on which they are found; the bottom of the foot is called the plantar aspect of the foot. A common misconception is that plantar warts have seeds or roots that grow through the skin and can attach to the bone. The wart may appear to have a root or seeds, but these are in fact small clusters of the wart just beneath the top layer of the skin. The wart cannot live in any tissue except the skin. Moist, sweaty feet can predispose to infection by the wart virus. They can be picked up in showers and around swimming pools. They are not highly contagious, but being exposed in just the right situation will lead to the development of the wart. Avoiding contact in the general environment is nearly impossible. If a member of the family has the infection, care should be taken to keep shower and tile floor clean. Children who have plantar warts should not share their shoes with other people. Young girls often share shoes with their friends and this should be discouraged.

Diagnosis

The warts have the appearance of thick, scaly skin. They can occur as small, single warts or can cluster into large areas. These clustered warts are called mosaic warts. They often resemble plantar calluses. A simple way to tell the difference between a wart and a callous is to squeeze the lesion between your fingers in a pinching fashion. If this is painful, it is likely that the lesion is a wart. A callous is generally not painful with this maneuver but is tender with direct pressure by pressing directly on the lesion. Other lesions on the bottom of the foot that are often confused with plantars warts are porokeratoses and inclusion cysts.

Treatment

Chemical Treatment

Various topical acids are available. Most are salicylic acids of different strengths that are applied directly to the wart daily. The effectiveness of this treatment is completely dependent on patient compliance and proper debridement of lesions. We recommend weekly debridements by a specialist. It is very important to debride off all of the dead skin in order for acid applications to continue to be effective.

5% Flourouricil is an anti-cancer drug used safely and effectively on warts. This is a protein inhibitor that is applied by the patients nightly and debrided by the doctor weekly.

Bleomycin is an injection that can also be used.

Laser treatment

Many different laser treatments are being discovered and utilized. Here are a few more common ones.

CO2 Laser: Used to cut and vaporize the wart. There are many techniques. Cutting around the lesion will allow a complete excision of the wart while cauterizing the blood vessels. Defocusing the laser or making small streaks with the laser over the body of the wart will vaporize the lesion and create a mild burn or blister. This will evoke an immune response within the body which will help heal the wart from the inside out.

Pulse Dye Laser: A newer technology and offered by the Feet For Life Centers. The success rate is reported as high as 95%. The device emits a tiny but powerful pulse of light that is absorbed by the pigment within the red blood cells of the wart. The light is generated when the lasing medium, a concentrated dye, is stimulated by a flash lamp energy source. This light is then directed at the wart using a pencil-like hand piece. The absorption of the light by the cells of the wart results in the cutting off of the wart's nutritional blood flow.

The pulsed dye laser is safe and effective because of its unique ability to selectively treat the wart without adversely affecting the surrounding skin. Patients generally require no anesthetic which means no painful injections prior to treatment. There is also no risk of scar formation or infection because the skin surface is not broken. The patients can pursue any activity the following day. Debridement prior to treatment is very important. Multiple treatments may be required.

* Pulse Dye is more effective if the wart(s) have not been treated with other prior methods. For more information on the Flash lamp Pulse Dye laser click below.

Surgical Treatment: Blunt dissection: Surgically cutting around the lesion. Punch biopsy can be used. Area will bleed post op. Local anesthesia is necessary. There is a risk of scarring.

Cryogenic Treatment: (liquid nitrogen) Applied with a probe or applicator directly to wart. Will create a burn and can scar. Good post op immune reaction.

Hyfercation: Using an electric needle to hyfercate the wart. The lesion will vaporize at certain settings and will burn at higher settings. Can be used as a cutting tool.

Needling: Repeatedly puncturing the lesion with a needle. This is followed often with an injection of cortisone into the wart.