Plantar Warts

a hand peeling off a bandage showing the plantar wart on the bottom of their foot

What are plantar warts? 

Warts are a growth on the skin that is caused by a viral infection from the Human Papilloma Virus (HPV). There are over 100 different strains of HPV, but only a few cause warts on your feet. The others are more likely to cause warts on other areas of your skin & body eg. hands, face or genitals. A wart that you find on the sole of your foot is officially called a verruca wart or plantar wart.

Although they're not related to pressure and can be found anywhere on the feet, you'll often find them on your heels or other weight-bearing areas. 

Plantar warts are not usually a serious concern for your health, however due to their contagious nature and if they are causing you pain and discomfort, we recommend seeking advice and a treatment plan from our podiatrists. 

Causes & risk factors

HPV is a slow-growing virus that is transmitted by direct or indirect contact. This means you could get it directly from someone who has the virus (e.g. skin to skin contact), or by sharing floor surfaces, shoes or socks with someone infected. However, not everyone that comes in contact with the virus will develop warts, as each person's immune system responds differently to the viral strains. 

The virus thrives in warm, moist environments, so is commonly picked up from communal areas such as public showers and pools, entering your body through a cut or a break in the skin.

This virus attacks the skin on the bottom of your feet, causing the top layer of skin to grow rapidly and form a fleshy raised lesion.  

Anyone can get a plantar wart. Nonetheless there are a number of factors that can increase your risk of getting a foot wart, including;

  • Children & teenagers. They are more common in children & teenagers, due to increased exposure from public spaces e.g. school pools, and they are still building immunity to viruses. 
  • Weakened immune system
  • Walking barefoot in communal areas especially where the virus thrives e.g. locker rooms & showers.
  • Cuts, injuries or skin infections on your feet that become a portal of entry for the virus
  • Having direct contact with someone with warts 

Symptoms

Plantar warts can present at all shapes and sizes. As it is a viral infection, tiny blood vessels grow at the core of the wart. These tiny vessels supply it with blood and nutrients, and often appear as little dark spots in the centre of the wart. It is common to experience pain from a plantar wart, particularly if it is on weight-bearing area  of your foot. The pressure that your body weight places on the wart is what makes it uncomfortable.  

Some common symptoms you may experience if you have a plantar wart:

  • A small, rough, grainy lesion that is growing on the sole of the foot (usually on the toes, the ball of the foot or the heel region).
  • The fleshy lesion has a solid border.
  • Black dark spots in the lesion.
  • Can have overlying hard skin with a yellowish appearance.
  • Pain when squeezing the outside margins of the lesion. 
  • Pain when walking if it's on a weight-bearing area of the foot.
  • A lesion that disrupts the normal skin lines and patterns on your foot
  • There may be multiple lesions in a similar location. This is called a mosaic wart.

A close up of two plantar warts with dark spots

Diagnosis

If you experience some or all of the symptoms above, you may be able to diagnose yourself with a simple test. It can be done using The Squeeze Test. This can help to identify whether you have a wart or a corn

The Squeeze Test
Simply squeeze the area from either side — if this elicits pain, it is more likely a wart versus a corn.

To ensure you get an accurate diagnosis, we recommend seeing one of our podiatrists, as the treatment for a wart is very different to the treatment for a corn. Your podiatrist can usually tell if your skin growth is a wart just by looking at it, but if it is still not clear, a sample may be taken to be analysed and confirmed. 

A woman performing the plantar wart squeeze test on the bottom of a foot

Treatment

Generally, warts will go away on their own, but plantar warts often require active treatment and removal because they can be very painful based on their location on the sole of the foot. Some warts go away after a few treatments whereas long standing warts can take several months to be fully resolved.

Podiatrist’s can help in a number of ways, including:

  • Use Swift Therapy, medical microwave technology that is highly effective in resolving warts.
  • Sharp debridement to remove the hard outer layer of the wart tissue
  • Use of mild acids to burn away the wart tissue
  • Use of cryotherapy to freeze the wart
  • Minor surgery done under local anaesthetic for complete plantar wart removal

Swift Therapy

SWIFT uses medical microwave technology that is highly effective in resolving warts and verrucae.

The machine allows us to deliver a focused microwave signal into the skin, ensuring only the wart is treated. It rapidly heats wart tissue to 42-45ºC. This sudden increase in temperature can cause discomfort, however, as SWIFT treatments are very quick, discomfort only lasts a few seconds. Once the appropriate dosage has been delivered, you can walk out without dressings and in no pain. For most people, the warts will not require sharp debridement before using SWIFT. 

This technology has between a 75-83% success rate, which is higher than any other treatment currently on the market.

Find out more about SWIFT Therapy.

In clinic chemical treatments

There are two main topical chemicals used in clinics to treat your warts.

1. Silver Nitrate 

  • Most gentle chemical application 
  • The podiatrist would debride away wart tissue to expose blood supply and then apply silver nitrate to the wart tissue. 
  • The debridement and chemical application cause tissue trauma in attempt to kick start the body’s immune system into action.
  • Silver nitrate can cause a grey staining of the skin which will eventually wear off. 

2. Salicylic Acid 

  • This chemical is typically formulated into a paste-like substance, which is applied to the lesion after debridement.
  • Similarly, to silver nitrate, the chemical reacts with the skin creating tissue trauma in attempt to activate the body’s immune response.

Depending on the size of the wart and how long the infection has been present, you may require several treatments. We recommend these chemicals are applied every 1-2 weeks until resolved. In some cases, we may encourage you to apply an over-the-counter treatment in addition to these chemical treatments throughout your treatment period.

Cryotherapy

Cryotherapy is the technique where a freezing agent (usually liquid nitrogen) is applied directly to the wart. It's a very quick treatment but the freezing sensation can cause discomfort and a blister may form after, which will resolve in the days following the treatment.

It may be tender to walk on following the procedure but in most cases you require less treatments using this method versus the chemical treatments.

This treatment is usually repeated 2-4 weeks apart until resolved.

Surgical plantar wart removal

Curettage is a surgical procedure where the area around the wart is numbed by a local anaesthetic. The podiatrist then removes the wart tissue to expose healthy skin. Phenol chemical is then used to burn the wart tissue and silver nitrate is used to stem the bleeding. 

During the first few days post surgery, you will need to stay off the foot as much as possible, as it will be tender with weight bearing. Within 1-2 weeks most people are walking normally and pain is significantly reduced/resolved.

The success rate of this treatment is estimated between 65-85%.

At home treatment options

Over-the-counter

There are many brands of over-the-counter products e.g. Wart Off or Wartner. These over the counter remedies usually contain either; a mild concentration of salicylic acid or are a home freezing kit. If we were to recommend an at home treatment, we would suggest trying the wart off stick. Apply for 4 weeks following the directions on the packet and if this does not resolve the issue, contact our podiatrists for an appointment. 

Home remedies 

  • Duct tape to suffocate the wart
  • Apple cider vinegar
  • Garlic

Although you may know people who have had success with these remedies. It is important to remember that to successfully treat a wart, we need to stimulate an immune system response to combat the virus. These at home remedies have little to no evidence for success and can cause skin irritation and/or infection.  

What can happen if I ignore a plantar wart?

In 65% of cases, warts will clear up on their own and without medical intervention. However, if you ignore a severe plantar wart or a mosaic wart, the following could happen:

  • Prolonged pain and discomfort, resulting in more serious treatment down the track.
  • Changes in posture or normal gait if a painful wart is changing how you stand, walk or run and is causing muscle or joint discomfort.
  • The virus could spread to other parts of the body, causing more warts to develop.
  • You could pass on the virus to other people, including friends and family. 

Prevention

Here are a few tips to prevent warts from occurring in the first place:

  • Avoid walking barefoot in communal areas
  • Keep your socks and shoes clean
  • Keep your feet clean and dry
  • Avoid having direct contact with people with existing wart

FAQs

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