Plantar Warts

What are Plantar Warts?

            A plantar wart is a raised, painful lesion on the bottom of the foot that is due to a viral infection acquired underneath the skin. Although warts can be seen throughout the body, they are very common on the bottom of the foot and are generally due to HPV (human papilloma virus). Even a small, unnoticed break in the skin can allow for the virus to penetrate the foot and cause painful lesions that are very difficult to eradicate unless accurately diagnosed and treated by a podiatrist. Plantar warts can clinically appear individually or can be within a cluster, the latter of which is termed “mosaic warts.” They generally appear as callused lesions with black pin-point dots underneath which is a typical hallmark sign of a plantar wart. Skin lines also tend to traverse around the lesion and there is increased pain with squeezing of the lesion.

Causes

            There are various causes that can be attributed to the development and progression of hallux rigidus. Common causes can stem from the patient’s bony anatomy to faulty biomechanics that cause the joint to become arthritic over time. Depending on how you walk, the joint can be over-utilized and cause the underlying cartilage to become damaged. Injuries and traumatic causes can be attributed to progression of hallux rigidus as well. In addition to extrinsic factors, a patient may have systemic issues which can also affect the integrity of the joint. Inflammatory arthropathies such as psoriatric arthritis, rheumatoid arthritis and gout can be implicated in the development of hallux rigidus. In any case, it is crucial for your surgeon to determine the underlying cause of the underlying arthritis before pursuing definitive treatment.

Diagnosis

The diagnosis of plantar warts is generally clinical. Occasionally, lesions that are suspicious or do not fit the dermatological criteria of plantar wart will be biopsied by your foot and ankle surgeon and sent to a pathology lab where a definitive diagnosis can be made.

Treatment

Depending on the location and severity of the plantar warts, there are a multitude of treatment modalities that can be executed to eradicate the wart for good.

  • Cryotherapy and application of topical salicylic acid—your podiatrist will shave the lesion down as much as possible before freezing it with liquid nitrogen in the office. You will then apply topical salicylic acid on the lesion daily and follow-up with your physician every 2 weeks until progress is made.
  • Surgical excision with CO2 laser ablation—This procedure is performed in the operating room under anesthesia. The wart will be surgically excised and a CO2 laser will be utilized to ablate the viral cells under the skin to hopefully ensure that the wart does not return. There will be several weeks of wound care and weight bearing restrictions post-surgery depending on the severity and location of the wart.
  • In-office Microwave Treatment Wart Removal—The newest technology in our office utilizes microwaves to heat the lesions quickly and stimulate an immune response which will eradicate the wart. The treatment takes 10 seconds total, is of minimal discomfort and does not require any home wound care or medication application. The procedure is done a total of 3 times spaced 4 weeks apart. Initial anecdotal evidence shows this procedure to be superior to others regarding permanent removal of warts [insert Swift link here.

Your surgeon will discuss all options with you and determine the best treatment course depending on the severity and location of your plantar warts.