Know all about Plantar Warts

What is Plantar Warts?

Plantar warts are small growths which occur over the plantar surface of your feet (soles). They can arise over the heels, front region of the sole, beneath the big toe etc. They occur mainly in the weight-bearing areas of the foot. When the plantar wart grows inwards beneath the skin it is called a callus, which is a hard lump. Plantar warts are common in children and young adults. Especially in individuals who walk barefoot and in people who have a week immune system like diabetics, cancer patients, in those suffering from AIDs have a higher chance of getting plantar warts.

What causes plantar warts?

Human papillomavirus (HPV) is the cause of plantar warts. When there are cuts, cracks or damage to the skin, the virus can enter into the body through them. All individuals who get infected with the HPV virus do not develop warts. However, in some, the virus multiplies in the skin of the sole and form plantar warts.

Figure 1 Close-up picture of Plantar Warts

Symptoms of plantar warts:

1. Plantar warts occur in the sole, especially in the weight-bearing areas.
2. They appear as a growth which is skin colored or fleshy.
3. They can be single or multiple (as clusters)
4. It is rough to touch and the surface is irregular.
5. The lesion can be raised from the surface or flat.
6. There are tiny black spots over the growth. They appear due to clotted blood vessels and are called “wart seeds”
7. Plantar warts are usually small. But they can become large.
8. When the wart grows inwards, it can cause a callus. The area is hard with thickened skin which is well defined.
9. Pain when walking or standing for long periods
10. When pressed on it, will cause pain (tenderness)
11. The usual lines and ridges of the sole are disturbed by the lesion

Figure 2 Picture of Plantar wart

What are the complications of plantar warts?

Complications are rare

12. Infection or ulceration – especially when you scratch your warts often or try to cut it off by yourself
13. Disturbance to gait and posture – when there are pain and tenderness the person may alter his or her posture to relieve the pain

 Plantar warts treatment:

Plantar warts are not a serious health issue. You can let them be especially if they are asymptomatic and they are usually harmless. Even without treatment, they will heal spontaneously with time.

However, if it is a cosmetic concern or it interferes with walking and if there is the pain then healing plantar warts becomes important. For that, you can try home remedies or over the counter products to get rid of plantar warts.

Below are the possible home remedies and over the counter products for plantar warts treatment

Home remedies for plantar warts treatment:

14. Do not scratch warts or attempt to cut it off by your self – like damage to the skin can lead to spreading of warts
15. If touch warts, wash your hands well to prevent spreading to other areas of the skin
16. 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 a separate one for warts.
17. 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 the same procedure until wart is totally removed.
18. 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. This, although helps, is not a proven remedy and is time-consuming.

What are the available over the counter products for healing or removal of plantar warts?

19. Application of topical solutions containing 50% Salicylic acid

Salicylic acid is keratolytic which removes dead skin. This has to be applied regularly for a long period. Make sure that the liquid is applied only on the wart and not over the surrounding skin as it can burn the normal skin leading to damage. Applying salicylic acid will burn the wart and peel off the layers of skin covering the wart. Read the instruction leaflet carefully. The treatment should be continued at least for 3 months.

20. Use of TCA (Tri-chloro acetic acid) to burn the lesion at least weekly for a few weeks

21. Topical formic acid solutions over the warts

22. Using plantar wart remover medicated patches and concealing pads – they contain salicylic acid as the main ingredient

23. Wart remover sticks – which has topical salicylic acid is easy to use than applying the liquid solutions and can apply directly over the wart without touching the normal skin
24. Some OTC topical solutions are available with added tea tree oil and cedar leaf oil to salicylic acid. When the liquid is applied continuously the wart will die and the dead tissue can be peeled off within 1-2 months.

25. 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.

When should you see a doctor?

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

The doctor will do paring of the wart with a scalpel followed by burning the lesion with cryotherapy or liquid nitrogen and freeze it. If lesions are severe surgical removal or LASER treatment is considered.

Plantar warts are difficult to eliminate. Even after successful removal, they can recur, so healing plantar warts at the first when it appears is essential.

Prevention of plantar warts

33. Avoid walking barefoot- Using footwear is advised when walking in common areas like swimming pools or locker rooms.
34. If you have plantar warts do not touch them often. If touched wash hands well with soap and water to prevent spread.
35. Keep your feet clean and dry
36. Wear clean socks and shoes
37. Look after your feet especially if you are a diabetic
38. Do not share socks and shoes
39. 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.