Plantar Warts Removal

Plantar warts are small growths which occur over the plantar surface of your feet (soles). They occur mainly in the weight-bearing areas of the foot. Plantar warts are common in children and young adults, especially in individuals who walk barefoot and in people who have a week immune system.

Human papillomavirus (HPV) is the cause of plantar warts. When the virus gets in through a cut or damaged skin, it multiplies within to form plantar warts. Sometimes inward growths can lead to callus formation.

People often search for the best way to get rid of warts but most warts will go away even without treatment after 1-2 years. However new warts can appear nearby. You may want to get rid of them especially if you are cosmetically concerned or they disturb your day to day activities such as difficulty in walking and standing due to pain and tenderness.

Figure 1: Warts on finger

Figure 2: Warts on face

Treatment of plantar warts:

Plantar warts are not a serious health issue. You can let them be especially if they are asymptomatic as they are usually harmless. Even without treatment, they will heal spontaneously with time. Sometimes removal of them by yourself can cause more harm than letting it stay, especially if you do not remove it properly, so planter wart removal by yourself needs doctor consultation. The best way to get rid of warts is to try some of these home remedies, making sure that surrounding normal skin does not get damaged by your attempts. Damage to the skin can lead to infection.

Home remedies

• Home pedicures – Immerse your feet in a basin of warm water with a little shampoo. Leave for 10 -15 minutes. Gently smooth the surface of the wart with a pumice stone or emery board. Always keep separate tools for warts.
• After soaking the wart apply duct tape over it and leave a few days. Once removal of the tape can rub off the wart which is softened with a pumice stone. Repeat same procedure twice a week until wart is totally removed.

(Garlic paste or apple cider vinegar soaked an in a cotton ball can be applied over the wart and covered with duct tape, will help soften the area more than just soaking with water)

Over the counter products for plantar wart removal

If home remedies were not successful, there are products available over the counter which can be used to apply over warts every day or weekly (depending on the instructions given), to remove the wart layer by layer. It may take time to totally remove the wart, so one needs to be patient.

• Application of topical solutions containing 0.5-30% Salicylic acid – Salicylic acid is keratolytic which removes dead skin.

(Some OTC topical solutions are available with added tea tree oil and cedar leaf oil to salicylic acid which makes it more effective in wart removal)

Figure 3: Planter warts removal treatment

Figure 4: Planter warts

• Use of TCA (Tri-chloro acetic acid) to burn the lesion – This is a strong acid which burns the wart and kills the virus. So caution should be taken to apply it only over the wart. You may need the help of another person if difficult to apply it by yourself.
• Using plantar wart remover medicated patches and concealing pads – they contain salicylic acid as the main ingredient – these are safe and easy
• Wart remover sticks –has topical salicylic acid which is easy to use than applying the liquid solutions. Apply directly over the wart without touching the normal skin

Whatever the topical product you select, make sure that you comply with the instructions. When the medication is applied continuously the wart will die and the dead tissue can be peeled off within 1-2 months. However, if the normal skin is burnt, there is possible damage to skin leading to infection.

• Pain relief – when there is pain an OTC product like acetaminophen (Tylenol), ibuprofen or aspirin can be tried. Be cautious about the dose and frequency of administration. The pain medication can be continued even for pain following wart removal.

What can go wrong while trying out home remedies and OTC treatment?

• Damage can occur to normal skin surrounding the wart – make sure you do not scratch or attempt to cut the wart by yourself
• Pain during and after the procedure
• Infection and ulceration
• Recurrence of warts even after successful removal
• Can end up with scarring and change of skin color in the area – this can look worse than the original wart itself

How to take care during and after treatment?

• Always read the instruction leaflet carefully before trying any OTC medication. Comply with instructions
• Make sure you apply the liquid only on the wart and not on surrounding skin
• Use pain medication to help relieve pain (Tylenol, aspirin, ibuprofen etc.)
• Do not be overenthusiastic and burn the area too much
• Be patient – treatment takes time, you may have to wait at least 1 -2 months for complete wart removal
• If the skin gets damaged, keep the site covered with a plaster, clean and dry
• If infection sets in always seek help

When should you see a doctor?

• When the lesions are spreading and enlarges with time
• When it doesn’t respond to OTC treatment or becomes worse
• When plantar warts cause pain and tenderness which interrupts your day to day activities, walking, standing etc.
• When there is bleeding from the wart
• When the wart changes in color – turn purple or black
• If you are a diabetic – as diabetics have a loss or reduced sensation over feet, feet should be looked after well to prevent gangrene (dead tissue) or chronic non-healing ulcers.
• When you have a week immune system plantar warts tend to be severe and widespread, it is best to seek help

What are the techniques which a doctor will use for wart removal?

A doctor will use one or a combination of the following treatment options.

• Stronger peeling medications – Salicylic acid with a stronger strength (50-60%) can be prescribed. This will remove layers of the wart more effectively as it is stronger. Even this should be applied repeatedly to get rid of the whole wart and it takes time.
• Freezing the wart with Cryo therapy – The doctor will apply liquid Nitrogen to the wart. This burns and freezes the wart and forms a blister. With time the blister sloughs off along with dead tissue of the wart. May have to repeat the procedure twice a week, until all warts are removed. Sometimes paring the wart with a scalpel is done before applying liquid nitrogen for better results.

This method is painful. If the doctor is not careful, can accidentally burn the surrounding normal skin. Depending on the burn, if blisters are deep, one can end up with discolored skin and scarring. Due to pain, this method is best avoided in children.

• Trichloroacetic acid (TCA) – A stronger strength of TCA can be used by the doctor to apply on the wart. A wooden toothpick is used for this procedure. The wart will be burned due to the acid.

Pros – This is not an invasive method

Cons – This treatment should be repeated weekly for a month or so for successful wart removal. The person can feel stinging and burning sensation.

• Surgery – Depending on the size of the wart the doctor will decide on surgery. Although it is a minor surgery, it will leave a scar.

Pros – the wart will be removed in one go

Cons – May have pain during and after the procedure even with local anesthesia. A scar is left as a mark.

• LASER treatment – The LASER rays are used to burn and cauterize the blood vessels and tissues of the wart. Once the tissue is dead, it falls off eventually.

Cons – It is costly, painful and a scar will be left

If you attempted OTC medications but failed and infection and ulceration occur following treatment –

The doctor can arrange cleaning and dressing of your ulcer, prescribe a course of oral antibiotics if necessary.

Take home messages –

• Plantar warts are difficult to eliminate. Even after successful removal, they can recur.
• Be patient while treating warts as it takes time

Prevention of plantar warts:

As warts have a tendency to recur, it is best to try these methods in order to prevent getting them again.

• Avoid walking barefoot- Using footwear is advised when walking in common areas like swimming pools or locker rooms.
• If you have plantar warts do not touch them often. If touched wash hands well with soap and water to prevent spread.
• Keep your feet clean and dry
• Wear clean socks and shoes
• Look after your feet especially if you are a diabetic
• Do not share socks and shoes
• HPV vaccine – The vaccine is not proven effective yet, although it can be tried. However, the strains of HPV causing the plantar warts are not covered by the vaccine.

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