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Plantar Warts

by Stephen M. Pribut, DPM

Plantar Warts: Cause

Warts are caused by a viral infection. The virus penetrates through the skin and may often enter through traumatized or damaged skin or areas that are under repetitive stress. Warts are often spread in moist areas which have remnants of infected skin such as locker room floors or the surfaces surrounding swimming pools. Warts can appear on any skin surface. On the sole of the foot they are called "plantar warts". Plantar is the scientific term for undersurface or the bottom of the foot. The virus that causes warts is the Human Papilloma Virus (HPV) of which more than 100 types exist. The subtypes of HPV most often associated with plantar warts are: 1,2,4,27 and 57.

The HPV (Wart Virus) is spread by direct contact. Quite often a moist area that has "skin residue" is an area at risk for spreading warts. This includes gym locker rooms, showers and swimming pools. Protective sandals can be helpful in prevention.

According to the American Podiatric Medical Association children and teenagers tend to be more susceptible to warts than adults. Some individuals are immune to warts and those with conditions which cause immunosuppression are more susceptible to warts.


Identifying Warts

Many corns or calluses on the foot are mistaken for warts and the converse is also true. Occasionally a more serious problem will appear on the skin of the foot. This may include certain types of carcinomas and melanomas. These conditions can sometimes be mistakenly identified to be a wart. The American Podiatric Medical Association and the American Academy of Dermatology believe it is wise to consult a specialist when any suspicious growth or eruption is detected on the skin of the foot in order to ensure a correct diagnosis.

Warts, corns, and calluses are all hard and flat. The wart generally has a better defined peripheral boundry.Warts on the hands, fingers or top of the foot or toes are usually more raised. Plantar warts differ in color but are often gray. The center frequently has pinpoint black spots that represent areas of bleeding within the wart. This is one of the hallmarks of a wart. A wart will also often have pinpoint bleeding when it is debrided (trimmed) by a physician.

Untreated warts can grow to more then an inch in diameter and spread to clusters of warts or even to the other foot. Warts are spread by touch or contact with skin that may shed from another wart which includes either your own or someone elses wart infected skin.

On the bottom of your foot warts can be painful. Atheletes should have these professionally treated, since altered gait from pain in your foot can throw off your normal stride and lead to injuries elsewhere in your foot, legs, or back.

Wart

Tips for Prevention

 

  • Avoid walking barefoot in locker rooms, pools, gyms, and most other public areas.
  • Use protective slippers or sandals in public areas.
  • Avoid direct contact with warts from yourself with other body parts or from other people.
  • Check children's feet regularly.
  • Keep your feet clean and dry. Use Coolmax or other socks made of wicking material.
  • Do not ingnore changes in your skin.

 

Self Treatment


Self treatment is not usually advisable. It is too easy, even for professionals to misdiagnose warts. Plantar warts are more difficult then other warts to diagnose since they are mishapen by the pressure of walking. Over-the-counter preparations usually contain acids that damage, destroy and kill skin cells. These preparations are caustic to the skin and may be even more caustic to normal skin then to the hardened skin of the wart itself. Self treatment should always be avoided by diabetics and in individuals with cardiovascular or circulatory disorders.

Office Treatment

A variety of options exist for in office treatment of warts. Acids in combination with periodic careful trimming of the wart is a frequently used option. Other medications are also used. Surgical removal, electrical destruction, freezing and laser are all options that may be used to treat your wart. Salicylic Acid is the one of the most often used therapies. Bleomycin, Aldara, and a variety of other topical and injectable agents have been used. The Cochrane Medical Database indicates that for the most part insufficient evidence exists to favor one method over another.

 

Wart Tips:

  • Seek professional evaluation and assistance with the treament of your warts if they have persisted, cause pain, or spread.

  • Diabetics and other patients with circulatory, immunological or neurological problems should not self-treat their warts.

  • Warts may spread and are catching. Make sure you have your warts evaluated to protect yourself and those close to you.

References:

Gibbs S, Harvey I. Topical treatments for cutaneous warts. Cochrane Database of Systematic Reviews 2001, Issue 2. Art. No.: CD001781. DOI: 10.1002/14651858.CD001781.pub2 (online at: Cochrane Medical Database Cochrane Medical Library 2007. Accessed October 18, 2007.)

de Villiers, E.M., Fauquet, C., Broker, T.R., Bernard, H.U., & zur Hausen, H. (2004). Classification of papilloma viruses. Virology, 324, 17-27.

 

 

 

 

 

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