Warts (Verruca Plantaris)

Warts are one of several lesser afflictions of the foot, which nevertheless can be quite painful. They are caused by a virus, which typically invades the skin through small cuts and abrasions. They are frequently called plantar warts, because they appear most often on the plantar surface, or sole, of the foot. They can appear anywhere on the skin, however, and technically only those on the sole are actually called plantar warts.

Children, especially teenagers, tend to be more susceptible to warts than adults; some people seem to be immune, and never get them.

Identification of a wart

Most warts are harmless and benign, even though some can be painful. They are often mistaken for corns, which are layers of dead skin that build up to protect an area which is being continuously irritated, whereas a wart is a viral infection.

It is also possible that a variety of other more serious lesions, including carcinomas and melanomas, although they are not overly common, can be mistakenly identified as warts. Because of those identification problems, and for pain relief, it is wise to consult a chiropodist about any suspicious growth or eruption on the skin of the feet.

On the bottom of the feet, plantar warts tend to be hard and flat, rough-surfaced, with well-defined boundaries; they are generally fleshier when they're on the top of the feet or the toes. They are often grey or brown (but the colour may vary), with a centre that appears as one or more black pinpoints.

Plantars Warts are often contracted by walking barefoot on dirty surfaces or littered ground where the virus is lurking. The virus is also sustained by warm, moist environments, which means warts are often associated with communal bathing facilities – such as wet shower surfaces, rather than transmission in deeper water, which is quite rare.

If left untreated, warts can grow to an inch or more in circumference, and they can spread into clusters of several warts. Like any other infectious lesion, they are spread by touching and scratching, and even by contact with skin shed from another wart. They may also bleed, which is another way they can spread. 

Warts last for varying lengths of time, but can average about 18 months. Occasionally, they spontaneously disappear after a short time, but this is not typical. warts can also re-occur in the same location, especially when left untreated. When warts develop on the weight-bearing areas of the feet (e.g. the ball of the foot, or the heel) they can become a source of very sharp, burning pain. Pain occurs when weight is brought to bear directly on the wart, although pressure on the side of a wart can create pain that is just as intense.

Tips for Prevention

• Avoid walking barefoot, except on sandy beaches
• Change shoes daily
• Keep feet clean and dry
• Check children's feet periodically
• Avoid direct contact with warts, from other persons, and from other parts of the body
• Do not ignore skin growths or changes in your skin.

Self-Treatment

Self-treatment is generally not advisable. Over-the-counter preparations contain chemicals that destroy skin cells, and it takes an expert to destroy abnormal skin cells (warts) without also destroying surrounding healthy tissue. Self-treatment with such medications should always be avoided by diabetics and those with cardiovascular or other circulatory disorders, which cause insensitive feet. Never use over-the-counter treatments in the presence of an active infection.

Professional Treatment

It is possible that your chiropodist will wish to prescribe and supervise your use of a wart removal preparation. Removal of the wart by simple surgical or laser procedure may also be indicated.

A common and very effective treatment is the use of cantherone, a blister-forming agent. This causes the underlying wart to be shed as the blister heals.

Another form of treatment is cryocautery, which involves freezing the wart with liquid nitrogen or another agent. The chiropodist would first use a blade to remove layers of dead skin which the body has formed over the wart to protect against irritation, then apply the solution with a cotton swab or another applicator. Often a second application, some days after the first, is required, and occasionally additional treatments are necessary (especially when several wart clusters are present).

Another removal process is laser surgery. Use of the Cutera laser for wart removal is growing much more common and offers great success with virtually no down-time.