Plantar Wart Causes, Symptoms, & Treatments
Plantar Wart Causes
Warts are the result of a virus. To be specific – the HPV (Human Papilloma Virus). There are over 100 viruses in the HPV family. Warts have been documented since as early as 100 A.D.
This particular virus often invades the skin through cuts, scrapes, or other various issues through the skin, causing the bump you see on your foot.
Who Usually Gets Plantar Warts?
The vast majority of warts occur in people under 21.
Between 10 and 20% of school-aged kids have warts. We believe this age selection is related to the immune system. If you are one of the few adults that has a wart, you are probably going through your second “teenhood” or have a weakened immune system.
To give you a general rule of thumb: adults don’t get warts, and kids do not get calluses. 90% of the adults we see come into our practice thinking they have a wart and often have a completely different diagnosis – usually a callus or a tiny sealed sweat gland (Porokeratoma).
Location, Location, Location
The common areas warts like to hang out are the hands and feet. They will go to other areas of the body but those are the favorites. The same virus will look different on the foot vs the hand. One reason for this is that skin on the bottom of the foot is 40 times thicker than normal skin. So the wart on a foot has a much bigger playground so you do not see it rise above the surface of the skin. A wart on the hand has much thinner skin to poke through, which is why you can identify the cauliflower-like appearance.
The Swamp Thing
Warts love a moist environment and actively seek out sweaty teenage feet. If this problem is present we need to dry the area. This doesn’t mean towel dry! Specifically, we’re talking about hyperhidrosis (sweaty feet).
Symptoms of Warts
It Looks Like a Wart…
Warts have an appearance that is different from other skin lesions. The first classic finding is that they separate from normal skin lines. Skin lines give us our fingerprints…or toeprints. Any change of pattern is easily spotted, much like watching ripples in a still pond when a fish jumps out.
Looks Can Be Deceiving
Warts can appear as a solitary lesion or groups of lesions. A loner wart can be 2mm all the way up to 1.5 cm. Individual lesions can cluster together so there is no space between them. These can measure much larger than 1.5 cm and can be called a mosaic wart. This mosaic title is in reference to the tile pattern where a bunch of little tiles forms a big picture. Same idea for these plantar warts. There can also be a combination of single warts as well as mosaic warts.
Oops They Did It Again (Misdiagnosis)
We get a lot of older people that were told by their doctor they had a wart and it has been there for over 10 years. This is a major clue that it isn’t a wart! Most PCPs don’t spend a lot of time looking at feet. Can’t blame them (that’s my job!). Warts have an expiration date and it ranges from 5 to 7 years. If the skin lesion has been around long enough to get a name and has not changed during this time, it is most likely NOT a wart. Just because it may be a callous does not mean it should be ignored.
There are a few imitators that will look like benign warts but may have devastating consequences. Chronic ulcers can look like warts. They can have an irregular surface and discoloration and convert to a malignant lesion. So if the age group is off and the lesion looks kind of like a wart, but your spider senses are tingling – get it looked at. The best-case scenario is a second adolescence where you are getting warts, while the worst-case scenario is a cancerous lesion.
Size Matters
Small warts can easily hide and produce no symptoms in the early stages. If a wart develops on the bottom of the foot in a weight-bearing area there will be problems. You may feel it before you notice the skin changes. A medium-to-large wart will feel like walking on a large ball bearing (but not as bad as a Lego). The time the wart begins and when it is noticed can be very different.
Treatment Options
There are over a dozen medical treatments for warts. There are hundreds of home remedies (we’ll discuss these in a bit). To be honest, the reason there are so many medical treatments is there there is no option that is overwhelmingly better. The success rate is in the 80-85% success range. That’s good, but not great.
Most of these treatment options fall into two categories:
Treatment Plan 1: Tissue Destruction
The goal here is to maximize wart destruction while minimizing healthy tissue damage.
This can be done in a multitude of ways but the bottom line is “Nuke the wart!”
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- Chemical Cautery (medication that irritates the tissue)
- Laser Treatments
- Cryo (freezing)
- Hyfrecation (burning)
- Ultrasound
- Microwave (heat destruction)
- Excision
This is the most common form of treatment, some of which patients are already familiar with. The KEY here is to control the depth of tissue destruction. Go too deep and the chance for scar, which can be just as painful, increases. If you don’t go deep enough, the wart won’t be destroyed. It’s like only cutting off the head of a dandelion and expecting the weed to go away.
Treatment Plan 2: Encourage the Immune System
Here we’re helping the body attack the virus. This involves sensitizing the body to the virus. This gets pretty complicated and involves immunotherapy and antigen manipulating. Unfortunately, this is not readily accessible or affordable outside a tertiary care center or clinical trials. There’s great hope in HPV vaccines, but there’s nothing that specifically addresses the plantar warts version of this virus.
Preferred Treatment Options
First, before we dive into our preferred treatment options, there are a couple of things we need to address. First, warts DO NOT go down to the bone. If someone told you that, they are pulling your leg. The wart does not go deep into the body.
There is a structure called the Basement Membrane that separates the skin’s deep and superficial layers. It is like a Kevlar tarp. It is pretty tough and blocks the wart from going to the deep tissue. If this membrane is damaged, the chance of scarring goes up. A scar is not a big deal in the hand but will be regrettable on the bottom of the foot.
Not to sound like a broken record, but if the treatment does not go deep enough, the wart will return. If the treatment goes too deep, it will pierce the Basement Membrane, causing a painful scar to form.
Our Preferences For Treatment
There are a few choices that minimize membrane damage. They each have pros and cons. And they all have the same success rate.
One choice is the cautery medicine which creates a lousy living environment for the virus. The virus eventually gets beat up and leaves. The treatment is pretty easy – application two times a day. But it MUST be done twice a day which becomes tedious. Remember, this treatment will often be for teens, pre-teens, or children. It can be a challenge to get them to do anything twice a day. The tissue damage is gradual and controlled. Unfortunately, there is no timeline for the virus to disappear. It could be weeks or months. If there are multiple or very large warts, this may be the better option as there are no limitations of activity with this treatment.
Our second option is to excavate the entire wart. This is known as curettement. The surrounding skin has to be anesthetized. That means an injection. The wart is removed in its entirety. The wart is in a capsule – a surrounded wall that separates it from normal tissue. This actually helps in removing the wart. Remember the Basement Membrane? This treatment allows good visualization of the membrane to avoid damage.
This option is good for single lesions that are less than 2 cm in size. Healing is typically finished within 2 weeks. Activity can resume in several days. Additionally, removing the wart is the best way to get a specimen sent to the lab to confirm it is a wart and not a more worrisome concern.
We do have a new third option for treating warts – laser therapy. Laser therapy is helpful as it just takes a few visits to help treat the wart. This is especially useful when used along with the above options.
Prevention
Warts can come back with a vengeance if treatment stops too soon. I recommend treatment until the skin looks normal then adding 1 month. Watch for normal skin lines to signal success.
Warts do not follow a constant rate of resolution. They may not change for weeks or even months and then disappear in a week. This can be frustrating if there is no improvement right away. We are dealing with viruses and the immune system and there is still a lot to learn in both areas.
Plantar Wart Myths
Home treatments are unique and vary depending on geography. I love collecting tales of these variations. If it involves a potato it probably came from Germany. If it involves a copper penny it is from England, and if the treatment involves duct tape it’s from the US.
Please let me know if you’ve found additional home remedies – I love hearing new stories!
There is a reason why so many individuals talk about home remedies. There can be a spontaneous exit for warts when they hit their expiration date – they can disappear spontaneously with or without treatment. So whatever treatment Granny G or Uncle Bob recommended at the time of resolution, it must have been the solution. We call this form of conclusion making a false positive – essentially reaching the wrong conclusion.
Wart…Seeds?
You cannot plant or harvest warts. There are no seeds? the tiny dark specs you may see are capillaries (small blood vessels). They have been damaged by the virus and leave a few blood cells behind. Our blood vessels are deeper than the superficial skin. The wart recruits more vessels for growth closer to the surface. That is why they can still bleed if you look at them sideways.
Wart Mysteries
Warts do not communicate with each other (as far as we know), but they can occur in the same place on both feet. Or show up years later in the same location.
In Summary – Take Home Points
- There is no magic want with warts. Studied treatments are all in the same success rate neighborhood (80-85%).
- The best treatment is one that is best for you – but schedule an appointment so we can help you come up with the best decision.
- Boredom is your biggest enemy for success. Miss or stop treatment and you’ll keep dealing with a wart problem.
- If one treatment has been given adequate time and shows no change, a change in treatment plans is advised. There are more than 2 ways to skin a wart. The 2 methods discussed earlier are not the only options but do have the lowest chance for scarring.
So if you are struggling, don’t be a worrywart – come in and see us for help.
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