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Understanding Plantar Warts / Verruca

Warts are one of several non cancerous, soft tissue conditions of the foot that can be quite painful. Wart lesions can develop anywhere on the body, but typically they appear on the bottom of the foot, hence the term plantar warts. They can occur at any age but children, especially teenagers, tend to be more susceptible to warts than adults, due to their less mature immune system.

What are the signs and symptoms of plantar warts? Warts may present in single or multiple lesions. A single wart often increase in size and may eventually multiply forming additional lesions called “satellite lesions”. A mosaic type is a cluster of several small warts growing closely together in one area. Most warts can be hard to identified. The wart lesion may resemble a callus or corn because of its tough, thick tissue. Corns and calluses are layers of dead skin that build up to protect an area which is being continuously irritated. This is where a misdiagnosis is common. The wart, on the other hand, is a viral infection. Plantar warts tend to be hard and flat, with a rough surface and well-defined boundaries; warts are generally raised and fleshier when they appear on the top of the foot or on the toes. The wart lesions under the foot are usually painful on standing and weight-bearing activity. Pain is also felt when the sides of the wart are squeezed. A corn is usually painful on direct pressure. Tiny black dots often appear on the surface of the wart. The dots are actually dried blood contained in the capillaries (tiny blood vessels) in the wart. When the lesion is pared down, these blood vessels generally show up as pinpoint bleeding. It is also possible for a variety of more serious lesions to appear on the foot, including cancerous lesions such as carcinomas and melanomas. Although rare, these conditions can sometimes be misidentified as wart. It is recommended that you consult a podiatrist, GP or dermatologist when any suspicious and abnormal growth is detected on the skin of the foot in order to ensure a correct diagnosis.

How do I get plantar warts? These warts are caused by direct contact with the human papillomavirus (HPV) that generally invades the skin through small or invisible cuts and abrasions. The virus is often acquired in public places where people go barefoot, such as swimming pools and locker rooms. The causative virus thrives in such warm, moist environments. It can also be acquired at home if other family members have the virus.

Are warts contagious? Yes, but the risk of passing them on is generally quite low. You will really need a close skin-to skin contact. As a thumb of rule, you are at a higher risk of being infected if your skin is damaged, or if it is wet and in contact with dirty surfaces or littered ground where the virus is lurking. If you have a poor immune system, you are also at a higher risk and may develop multiple wart lesions that are difficult to cure.

Do I need to treat the plantar warts? What if I left them untreated? Plantar warts are not usually a serious health concern and may go away even without treatment or last many years. In most cases, they are too painful to ignore. Warts should be treated if they are spreading (either elsewhere on your foot or to other members of the family), or continue to be painful. Depending on the location of the wart lesions, it may or may not cause any pain. Plantar warts, those on the soles of your feet generally make running and walking uncomfortable as they get pressed inwards on the sensitive nerves of the skin. The tenderness can cause compensation by posture alteration and can cause strain elsewhere in the body.

What are the treatments available for plantar warts? Wart treatment is progressive and there is no instantaneous cure. Treatments generally range from home remedies, supervised self treatment with over the counter topical treatments, acid, cryotherapy, liquid nitrogen and referral for surgical removal in more stubborn cases. Home remedies and self treatment are generally not advisable. There are over-the-counter preparations which contain acids or chemical that can destroy skin cells and it takes skills to apply the preparations to destroy the abnormal skin cells (warts) without destroying surrounding healthy tissue. Most self treatment also failed due to deeper and calluses formation over the wart lesions. Self treatment with such medications especially should be avoided by people with diabetes and those with circulatory disorders. Warts are often difficult to eradicate so perseverance and good patient compliance are necessary. The first level of treatment is using acid preparations (salicylic acid) and silver nitrate to destroy the warts. This treatment often requires multiple applications over the course of few weeks to remove the viral cells slowly and allows healthy skin cells to replace them.Other treatments include cryotherapy, which involves freezing warts with a very cold solution; electrocautery, laser therapy and surgery.

How do you prevent wart lesions in the first place?

The following tips may help to prevent plantar warts:

  • Avoid walking barefoot, especially in communal changing or shower rooms

  • Maintain good hygiene through changing of socks and shoes daily

  • Keep feet clean and dry

  • Check children’s feet periodically

  • Avoid direct contact with warts from other persons or from other parts of the body

  • Do not ignore growths on, or changes, in your skin

  • Visit your podiatrist should you notice any abnormalities on your foot

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