Plantar Warts

What is a Plantar Wart?

A wart is a small skin growth that is caused by a virus.  Warts can occur on any place on your foot, and a plantar wart is one which occurs on the bottom of your foot.  Warts more commonly affect children and adolescents.
There are two types of warts:
  • Single wart:  this is an isolated wart that may increase in size and even multiply on the foot by forming nearby warts.
  • Mosaic wart:  this is a cluster of several small warts that grow together.  These are normally more difficult to treat than single warts.

Symptoms of Plantar Warts

The symptoms of plantar warts may include:
  • Thickened skin:  often this resembles a callus on the bottom of the foot because it is on an area of increased pressure.
  • Pain:  warts can hurt while walking and standing.  They are also painful with side to side pressure.
  • Tiny black dots:  often appear on the surface of the wart and they are indication of dried blood of the tiny blood vessels around the wart.
Warts normally grow deeper in the skin over time and are more painful over time.  Therefore, it is beneficial to treat them early before they are very painful.

Causes of Plantar Warts

Warts are caused by a viral infection in the skin that appears on the bottom of the foot.  At times these infections can be contracted at public places like pools, showers and restrooms.  They are commonly found in individuals that have excess perspiration on the foot.
What is necessary to fight any viral infection is your body’s immune response.  Simply put, your body’s immune system has not recognized the virus or it is not large enough to destroy the virus.  Therefore, treatment is aimed at helping your body recognize the virus and build its own immune response to destroy the virus.

Diagnosis of Plantar Warts

Most of the time, we can diagnose a wart by taking a thorough history and doing a physical exam.  However, on occasion when a wart has been present for a prolonged time, is found on a different location, or is not being cured at the normal rate, a biopsy may be indicated.  A biopsy is performed by taking a small piece of the wart and having it examined to make sure it is not anything else on the foot.
Also, be aware that individuals with warts commonly have sweaty feet (hyperhidrosis) and athlete’s foot that should be treated as well.

Home Treatment

Even though most warts go away on their own over time, most patients desire faster relief.  The goal of treatment is to completely remove the wart.  There are many different types of remedies that people try, but many of these are unproven and may be dangerous.  Be especially careful if you have high risk diseases like diabetes, poor circulation or nerve disorders (neuropathy):
  • Acid treatment:  there are many over-the-counter treatments than can be a first-line treatment for warts.  However, if there is no response within a few applications, you should seek out a professional.
  • Drying agent:  if your feet sweat excessively, a drying agent like an underarm antiperspirant can be used just as effectively on the foot to decrease sweating.
  • Pumice stone:  together with the acid treatment and if the wart is not painful, pumicing after showering can help remove excess hard skin.
  • Stockings:  special stockings with copper or wick-away fibers can help decrease perspiration on the bottom of the foot.

Office Treatment

After you have exhausted home treatments or if they were unsuccessful, there are other treatment options for plantar warts:
  • Topical drying solutions:  prescription-strength drying solutions can help dry out the wart and initiate the body’s defense mechanism.
  • Topical antiviral cream:  helps your body activate its own immune response.
  • Wart destruction:  wart destruction can be done in the office using a number of modalities including acid, laser, debridement or freezing.
  • Oral medications:  have been found to be effective in treating the wart virus.

Surgical Treatment

When office treatments are unsuccessful or the wart is too large you can consider surgical excision.  Surgical wart removal  is performed by surgically removing the wart with or without closure of the wounds of the foot.  This is a very effective method of treating plantar warts but also has a possibility of wart recurrence after surgery.

Preventative Care

After a wart has been resolved it is always a great concern to not acquire them again.  Here are some ways to prevent recurrence:
  • Sandals:  wear shower sandals when at public locations including pools and restrooms.
  • Diminish perspiration:  a topical drying agent can reduce moisture, used together with socks that remove moisture.

Frequently Asked Questions?

Q:  Can duct tape work?
A:  There are many folk remedies to treat warts and this is one of them.  The way it works is that the removal of the duct tape helps your body’s immune system to recognize the wart.
Q:  Are plantar warts contagious?
A:  Plantar warts can be transferred from one person to another, usually in areas where you are barefoot, like the shower.  Care should be taken to clean the tub and floor and wear sandals. 
Q:  When should I consider surgical removal?
A:  After many months of unsuccessful conservative treatment or if the wart is too large and will unlikely clear up on its own.