Plantars Warts caused by the Human Papilloma Virus is a benign skin infection involving the bottom of the foot. These skin infections are unique to the bottom of the foot and do not spread to any other skin area on the body.

Children between 12-15 years of age appear to have the greatest likelihood of developing plantar’s warts. The risk of developing this infection has much to do with immunologic factors that may predispose an individual to this infection as well as the need for direct skin exposure with the viral element. The virus is community acquired and can be seen in high foot traffic areas like locker rooms. The wart virus is introduced via small cracks in surface of the skin.

The infection is generally self limited and can spontaneously resolve within one to two years. The infection generally will spread overtime creating a larger surface area of infection on the bottom of the foot. The wart is a raised lesion on the bottom of the foot that when observed closely has an irregular surface pattern, usually round and can have dark pinpointed regions in the body of the wart that are capillary blood vessels. Callous or corns on the bottom of the feet are commonly mistaken as warts. Callous’s generally occur on the high pressures areas of the heel and the ball of the foot and when closely observed don’t have irregular surfaces and capillary blood vessels as do warts.

Warts are often recognized by patients because pain occurs due to the thickness of the wart increasing pressure during walking activity.  The increase pressure placed on the underlying sensory nerves causes this pain response. Alleviating pressure from the wart tissue by padding around the wart can relieve this discomfort.

There are many forms of treatment for warts. All treatments are designed at creating an  injury at the skin level to help irradicate the wart.  Surgical excision, liquid nitrogen  cold therapy as well as topically applied salicylic acid wart agents are just a few of the approaches to wart treatment.

Creating an effective strategy for treating warts is very important. A single plantar’s wart may be most effectively treated by surgically removing the wart during an office visit while a wart that has spread may be better treated overtime with topical medications.

Surgical removal of warts is done in the office under a local anesthetic to provide anesthesia to the wart tissue. After the procedure warm water soaks and wound care is performed for a short period of time until skin healing has occurred. Complications for surgical excision are generally limited to recurrence 20-30% of the time if all of the original virus was not removed at the time of the procedure, infection and painful scarring.

Cantharone topical chemical application is a highly effective treatment for the plantars wart.  Cantharone is an extract of beetle juice that creates a sensitivity reaction to the skin when applied to the skin causing a blister to form.  Cantharone is applied painlessly in the office and allowed to dry. A bandaid is applied to cover the area of application and padding is dispensed to take the pressure off of the area. The application can caused a delayed pain reaction after the first day or two sometimes requiring pain medication. Patients are generally seen back in the office after two weeks to removed the blistered skin and reapply the medication if needed. Generally two to three applications are needed prior to complete wart resolution.

Following Canthrone application please follow the following:
Keep your foot dry for 48 hours.
Resume normal bathing and showering with protective use of a band aid and antibacterial ointment for the next week. You can expect a blister responses after the Canthrone
(If signs of infection including pain, swelling, redness, streaking from the site of Canthrone application call the office for advice at 543-7788/ 434-2009)
After the first week remove the calloused area with manual techniques as reviewed with your physician.
Begin the use of topical wart removal medications including any liquid salicylic acid including Occlusal- HP, Duofilm corn or callous removal agents.
The topical medication generally should be applied once daily to the wart and covered with an occlusive barrier including band aids or duct tape.
The occlusive barrier should be removed after 24 hours and the tissue should be again derided.
(If the wart region becomes excessively tender than reduce the daily application of topical medication and self treatment to every other day).

After successful wart treatment it will be important during the first few months post treatment to check the skin on the bottom of the foot thoroughly to ensure that all of the wart is gone and that there aren’t any remaining warts on the bottom of the foot.