Conditions of the Foot
by Dr. Mark H. Tompkins

Plantar Warts (Verruca Plantaris)

Plantar Warts (VP) are an extremely common skin manifestation which occurs on the plantar surface (bottom) of the foot which is caused by the human papilloma virus (HPV). The infection occurs most commonly in children and young adults between the ages of 8 and 18. The majority of people become immune to HPV by the second or third generation of life.

VP is characterized by hyperkeratotic (build-up of excess skin) lesions that form on the bottom of the foot. They are the same skin disease (HPV) process as 'typical' warts, which frequently appear on the hands and/or legs/arms. Due to unique characteristics of the layers of skin on the plantar (bottom) surface of the foot, and weight-bearing factors, the lesions become imbedded deeper into the tissues and frequently cause significant pain with shoe gear and ambulation.

VP may occur as a single, isolated lesion, or may multiply and coalesce into 'patches' of lesions-referred to as Mosaic VP. VP must be distinguished from other forms of hyperkeratosis which commonly occurs on the bottom of the foot. VP lesions tend to be more rounded in nature, frequently have black spots within the center portion, and hurt more when pressure is applied to the sides of the lesion (pinching). They tend to get larger with time, and most frequently spread to adjacent areas, to the hands, or to the other foot.

Plantar warts (VP) are treated with a variety of methods, depending upon the number and size of the lesion(s), the age of the patient, and history of previous treatment(s). There are no prescription-strength medications currently available for the treatment of VP. All OTC medications available for the treatment of mild cases of VP are combinations of 17% salicylic acid. These medications tend to be more successful in the treatment of warts anywhere other than the bottom of the foot (non-weight bearing surfaces). However, smaller numbered and sized lesions will frequently respond to this type of treatment.

The most common method of treatment for mild to moderate VP is via local excision. This is a relatively simple procedure performed in the office setting with a local anesthetic. Once the lesion(s) are anesthetized, they are surgically removed. A chemical called phenol is then applied to the base of the excision site(s) to kill any remaining HPV that may exist within the surrounding tissues. A larger, compressive bandage is initially applied and kept in-place until the following morning. After care is minimal utilizing warm foot soaks and application of a bandaid and antibiotic cream or ointment for a week or so. Pain is minimal and complete healing may take up to 4 weeks, with little change in activity level.

More severe cases of VP, Mosaic VP, or recurring lesions, are treated with the carbon dioxide (CO2) laser. This is performed as an outpatient procedure with the aid of twilight sedation and involves laser vaporization of the viral tissue. Healing times vary depending on the number and size of the lesions.

Success rates for the treatment of plantar warts are extremely variable. The number one complication with any level of treatment for VP, is reoccurrence . There is no known cure for viral infections, and successful treatment is dependent upon early diagnosis and appropriate treatment by a foot specialist.



Athletes Foot

Bio-Mechanical Pain


Calluses & Corns

Diabetic Foot

Flat Feet

Hallux Limitus/Rigidus

Hammer Toes

Heel Pain/Heel Spur

Ingrown Nails


Morton's Neuroma



Plantar Fasciitis

Plantar Warts

Running Injuries

Sclerosing Injection Treatments


Severs Disease

Shin Splints

Sweaty Feet/Odor

Toenail Fungus





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Dr. Mark Tompkins | 4402 Vance Jackson, Suite #146 | Phone: 210-341-2202

Copyright © 2001-2009 Dr. Mark H. Tompkins.  All rights reserved.