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
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.
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
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.
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.