Plantar warts, also known as verrucas, are a common skin condition that affects many individuals, young and old alike. These growths appear on the soles of the feet and can cause discomfort or pain during everyday activities like walking. Gaining insight into their causes, debunking myths, exploring treatment options, and adopting preventive measures are all important for ensuring foot health and overall comfort.
What Are Plantar Warts?
Plantar warts are non-cancerous growths caused by the human papillomavirus (HPV). They typically develop on pressure points of the foot, such as the heels or balls of the feet. Due to the pressure placed on these areas, the warts often grow inward, leading to more pain compared to warts found on other parts of the body. They are called plantar warts because they occur on the bottom (in medical terms, plantar) surface of the foot.
The virus enters the body through small cuts or abrasions on the skin, prompting the formation of these warts. While plantar warts are generally not harmful, they can be quite bothersome and may require treatment if they start to cause pain. Many people also want to treat them for aesthetic reasons, or to avoid spreading them to the people they live with.
Plantar warts often don't occur in isolation. Many people have more than one, either all on the same foot or spread over both feet. The warts can grow quite large, and sometimes a small cluster of warts will band together to create something known as a mosaic wart. That is simply a cluster of warts that have grown together, creating what appears as one, large wart.
Causes of Plantar Warts
The main cause of plantar warts is infection with specific strains of the HPV virus. These strains flourish in warm, moist environments, making public spaces like swimming pools, locker rooms, and shared showers hotbeds for transmission. HPV can survive on surfaces for up to 6 months or more, especially in warm, moist environments.
There are over 150 different strains of HPV. You may wonder if the HPV vaccine may help to prevent plantar warts; it does not. As of the date of this post, the HPV vaccine covers 9 strains of HPV, all of which have been associated with several types of cancers. None of these strains cause plantar warts. Plantar warts are caused by 6 different strains of HPV, none of which are associated with cancer.
Individuals with weakened immune systems or those who frequently walk barefoot in infected areas are more susceptible to contracting the virus. Research indicates that around 60% of people will experience HPV during their lifetime, showcasing the importance of awareness and prevention.
Myths About Plantar Warts
Numerous myths surround plantar warts.
Myth #1: Plantar warts grow roots deep into your foot.
This common misconception is entirely false. Plantar warts do not grow deeper than the dermis, a layer of your skin that contains sweat glands, oil glands, nerves, blood vessels, and - with the exception of your palms and soles - hair follicles. It is only 1-4 mm thick.
Myth #2: Plantar warts can easily spread to other parts of the body.
While warts can be contagious through direct contact or shared surfaces, it is less likely for them to spread from one site on the body to another. They require a break in the skin to develop, so merely having warts in one area does not mean they will spread elsewhere. Additionally, different strains of HPV cause warts in different areas of the body.
Myth #3: All types of warts are the same
There are several different types of warts:
Common warts are the most common type of wart (as the name suggests) and are usually found on the hands, particularly the fingers, although they can occur in other areas.
Plantar warts occur on the feet.
Filiform warts usually appear on the face, especially around the mouth, eyes and nose.
Periungual warts form around and under toenails and fingernails.
Flat warts usually appear on the face, especially the cheeks and forehead.
Genital warts are sexually transmitted and occur in/on the genitals, anus, mouth, and throat.
Myth #4: You Can Treat Warts with Banana Peels/Vinegar
Most home remedies for warts do not work. They neither damage the wart tissue, nor alert the immune system to their presence.
Myth #4: A Plantar Wart Will Eventually Go Away on Its Own
There are reported cases of resolution without treatment, but these are almost always in children with a very healthy immune system. For most, this is a potentially dangerous myth to believe, as it can allow a minor plantar wart to develop into a much larger issue. Many plantar warts will persist indefinitely if left untreated, potentially growing larger, and becoming increasingly painful and disruptive. Getting professional treatment is the wisest approach.
Treatment Options for Plantar Warts
Before starting a wart treatment, it is important to be certain that the lesion on your foot is actually a plantar wart. It can be difficult to tell the difference between a seed corn, a callus, and a plantar wart. A foot care professional or your doctor can help identify the problem.
No matter the treatment method, unless your plantar wart is very small - less than 3mm (1/8") - its very unlikely to be removed with one treatment. Most warts take several months and often multiple treatments to cure. Be wary of any treatment that advertises a "guaranteed" cure after only one use.
Some therapies are only safe when done by a licensed podiatrist, chiropodist, or physician (the most common physician will be a dermatologist, a doctor that specializes in skin problems). Treatments offered in spas by non-medical personnel are not approved by Health Canada and may cause more harm than good, if they have any effect at all.
Two at-home remedies may remove plantar warts:
Duct Tape: This is a common home remedy that gained support from some podiatrists and dermatologists. A piece of tape large enough to cover the wart is secured in place and worn 24/7 for 5 days, at which point the wart should be scrubbed with a pumice stone, aired out for about 12 hours, and then the process repeated if necessary. This method may not completely remove the wart.
Salicylic Acid: This treatment works by gradually peeling away the wart through consistent application. It is available in both over-the-counter and prescription strengths. Users typically find improvement after a few weeks. It is important to place the salicylic acid only over the wart, as it will also destroy healthy tissue.
If plantar warts become painful or fail to respond to at-home remedies, several effective medical treatments are available:
Cryotherapy: In a healthcare setting, liquid nitrogen may be applied to freeze the wart. This method aims to blister the wart, effectively killing the tissue and promoting it to fall off within a week or two. Most warts require more than one treatment. There are also over-the-counter cryotherapies that use a different liquefied gas to freeze the area. Sole Focus offers a form of cryotherapy for small warts of 5mm or less.
Laser Treatment: Laser therapy can be utilized to destroy the wart’s tissue. At least two treatments are required in most cases. Studies show that laser treatments can achieve a success rate of approximately 80%. This treatment should only be done in the office of a licensed podiatrist or physician.
Microwave Therapy: Another option uses targeted microwave energy to stimulate the body's immune response and eradicate the wart-causing virus. This involves between one and five treatments, depending on the size of the wart. This method is up to 83% effective. This treatment should only be done in the office of a licensed podiatrist or physician.
Minor Surgical Procedures: In cases where warts cause significant pain, a doctor may opt for surgical excision to remove them.
Immunotherapy: This method seeks to boost the body’s immune response to HPV. Prescription topical or injectable medications can stimulate the immune system to target the infection effectively.
Barriers to Healing
Plantar warts are hard to get rid of. Normally, when a virus invades the body, the immune system identifies it as foreign and mounts a defence against it. However, the immune system isn't as vigilant in the skin layers as it is in the rest of the body. In a few cases, warts will be eliminated by the immune system in about 2 years. In most cases though, the virus is able to hide from the immune system, allowing it to grow and thrive if left untreated.
Laser and microwave treatments for plantar warts cause local tissue trauma by heating or burning the area, which then stimulates an immune response and encourages the body to neutralize the virus. Cryotherapy works in a similar way, freezing the tissue and then shedding the damaged tissue. Salicylic acid similarly damages the local area. Duct tape is thought to work by making the skin extremely soft and damp, making the pumice more effective in removing it.
No matter what method you choose for treatment, it's important to remove as much of the callus that builds up around the wart prior to treatment. Calluses are thick skin that will prevent medication from reaching the heart of the wart. A trained foot care professional can safely reduce these calluses. You should never take a sharp object like a blade to your own feet to reduce your callus. Warts have their own blood supply and can easily be made to bleed, presenting a route for other infections.
Prevention of Plantar Warts
Preventing plantar warts is primarily about avoiding exposure to HPV. Here are some effective strategies to consider:
Keep Your Feet Dry: Prevent moisture, which allows HPV to thrive. Use foot powder in shoes to help moisture control.
Wear Protective Footwear: In communal settings, always wear flip-flops or waterproof sandals to shield your feet from potentially contaminated surfaces. Going barefoot outdoors can also increase your risk of developing a plantar wart, as you're more likely to get a small scrape or cut on your foot.
Disinfect Tub & Shower Areas: A 4:1 water to bleach solution will effectively kill the virus that causes warts. This should never be used on skin, only on hard surfaces, and then left to air dry. Several other disinfecting agents will also kill HPV on hard surfaces. Look for the word "virucidal" on the packaging, and use according to the manufacturer's directions. Vinegar is not sufficient to kill HPV.
Avoid Sharing Personal Items: Sharing shoes, socks, or towels can spread the virus, so refrain from doing so. Change your socks at least daily, and wash them thoroughly between uses.
Maintain Foot Hygiene: Regularly wash and thoroughly dry your feet. This is particularly important for individuals with foot issues or compromised immune systems.
Treat Cuts and Scrapes Promptly: Keeping cuts clean and covered minimizes the risk of HPV entering the body through broken skin. Antibiotic ointment does not help reduce the risk of contracting HPV, as it is a virus. Much like washing your hands for hygiene, if you wash your feet with soap and water, with 30 seconds of friction, you will remove up to 99.9% of pathogens from your skin.
Understanding and Managing Plantar Warts
Plantar warts are a common yet manageable condition. Understanding their causes, overcoming myths, and recognizing treatment and prevention options are essential for maintaining foot health. Whether opting for home treatments or seeking professional help, prioritizing foot hygiene and preventive care can help keep your feet healthy and wart-free.
An informed approach not only alleviates discomfort but also helps prevent future occurrences, allowing you to walk comfortably day after day. Always check with a healthcare professional if you have concerns about a wart or if it becomes bothersome.
Being proactive about foot health while understanding plantar warts is key to living an active and comfortable lifestyle.
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