What are Plantar Warts?
Warts are a common contagious infection in the outer layers of the skin which are caused by HPV (Human Papillomavirus). They can spread to other areas of our body and from person to person. Warts are generally very difficult to get rid of, as they are excellent at evading the body’s immune system.
The virus will often produce a thickened callus like growth that can become quite tender.
Risk factors for the development of plantar warts include:
- Public swimming pools or showers
- Trauma to the skin
- Compromised immune system
Warts can be spread from person to person so it is important to seek professional attention as soon as possible.
Signs and Symptoms
- A small, fleshy, rough, grainy growth (lesion) on the bottom of your foot, usually the base of the toes and forefoot or the heel
- Hard, thickened skin (callus) over a well-defined "spot" on the skin, where a wart has grown inward
- Black pinpoints, which are commonly called wart seeds but are actually small, clotted blood vessels
- A lesion that interrupts the normal lines and ridges in the skin of your foot
- Pain or tenderness when walking or standing
When to see a Podiatrist
- The lesion is bleeding, painful or changes in appearance or color
- You've tried treating the wart, but it persists, multiplies or recurs
- Your discomfort interferes with activities
- You also have diabetes or poor sensation in your feet
- You also have a weakened immune system because of immune-suppressing drugs or an immune system disorder
- You aren't sure whether the lesion is a wart
"The ideal verrucae treatment should result in resolution of all or a great percentage of warts, be painless, need only one or a part of a lesion treated, create no scarring and offer HPV immunity for a lifetime (Longhurst and Bristow, 2013)."
Depending on the clinical presentation we offer several different treatment options which may include:
- Salicylic Acid
- Multipule Puncture Technique (Needling)
- Swift Microwave Therapy
- Surgical Excision
The type of treatment can be influenced by several factors, such as:
- The length of time you've had the lesions
- The number and size of the lesions
- General health
- The type of Human Papillomavirus
Our goal is to ensure that every individual receives the proper care and treatment. All of the above treatment options have the potential to work. However, not all treatments necessarily work the same or produce the desired outcome.
The best evidence and thus the first-line approach for management of verrucae in children is topical salicylic acid (Evans and Matheison, 2010). It promotes wart regression by chemically debriding the wart of excess keratin and by inducing a local inflammatory response. However, in cases where warts are resistant to treatment, which is often the case in adults, salicylic acid may not be stuiable.
The number of treatments required on averages between 3-5 visits. However, this may vary depending on the size and severity of the wart.
Multiple Puncture Technique (Needling)
This technique is performed under local anaesthesia and involves needling the wart with the goal of activating the immune system within the individuals body that will eradicate the wart being needled and any other wart that may be present on both feet. This technique is particularly useful in treatment resistant cases or when there are multiple lesions present.
Occasionally the warts may fail to resolve or there is only partial improvement with this treatment technique. In these situations, we may repeat the procedure again or recommend another type of treatment.
Example of Treatment Progress
After Needling (8 weeks)
Swift Microwave Therapy
SWIFT is medical microwave technology that can be effective at resolving plantar warts. A focused microwave signal is emitted into the skin to a predetermined depth to ensure only the wart is treated.
A process called Heat Shock occurs within infected skin cells. This causes the wart to release certain proteins into the circulatory system, allowing the immune system to recognise the infection and begin to fight the virus.
Benefits of SWIFT
- Rapid treatment time
- No dressings required
- No need to self-care
- Pain relief post-treatment
- Few treatments needed
- Highly effective
Surgical excision may be considered when all other treatment options have failed. This procedure is usually performed under local anaesthetic via a tibial nerve or ankle block. This will numb the bottom of the foot allowing the wart to be removed.
Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.
Evans, A., Matheison, I. (2010). Paediatrics Pocket Podiatry. Churchill Livingstone.
Longhurst, B., & Bristow, I. (2013). The Treatment of Verrucae Pedis Using Falknor's Needling Method: A Review of 46 Cases. Journal of clinical medicine, 2(2), 13–21. https://doi.org/10.3390/jcm2020013
(2012). Treat cutaneous warts on a case-by-case basis, taking into account patient factors and the available clinical evidence. Drugs & Therapy Perspectives. 28. 15-19. 10.2165/11608610-000000000-00000.