Verruca (Plantar Warts)

Warts are benign tumors that commonly involve the skin and other epithelial tissues. The etiologic agents for these infections are a class of double-stranded DNA viruses called papillomaviruses. Warts are the manifestation and growth of a contagious virus (HPV, the Human Papillomavirus) that invades the skin through small cuts or abrasions on its surface - even through openings that are too small to be seen with the naked eye. Once inside the skin, the virus can grow and spread, stimulating the rapid generation of cells on the surface of your skin. There are over 60 different strains of HPV. Technically, warts may appear anywhere on the skin, but only those that appear on the soles of the feet are known as plantar warts.

If you see a bump on the sole of your foot that changes over time, suspect plantar warts. Both plantar warts and common warts (those occurring on other areas of the body) may be flesh-colored, white, tan or pink. Plantar warts are often grey or brown. Some warts may develop an uneven surface and a cauliflower-like texture over time, or they may acquire black spots or streaky lines. The black dots or lines are characteristic of plantar warts, and are caused by the bleeding of small blood vessels into the tissue. Warts also can bleed profusely when accidentally scratched or cut.

A wart may or may not be painful, depending on its location. Warts on the ball of the foot or the heel, for example, where weight and pressure are brought to bear, may cause the patient great pain.

You acquire the wart virus through direct contact with an infected person, or by coming into contact with an infected surface, such as a shower room floor. The virus lives in a warm, moist environment. It's generally difficult to tell when or where you came into contact with the organism, however, since the incubation period for the HPV can be up to three months, although a wart itself can lie dormant for years.

There are various preparations on the market which can be used to treat warts. However, it is essential to receive confirmation from your healthcare professional that the lesion you want to treat is, in fact, a wart, and not something else. By self-diagnosing and treating without medical supervision, you may actually do yourself more harm than good. Plus, since some of the remedies on the market contain acid, they can irritate, damage and scar normal skin, or worsen a condition that is not a wart.

Because a wart is a virus, the goal of the professional is to remove the affected area that contains the warty skin cells, while keeping damage to the surrounding tissue to a minimum. In this case, the doctor may choose one of several methods: Acid therapy or freezing the wart (also known as cryotherapy) is used as an initial treatment. The patient will notice that the affected area develops a blister, which falls away within a week to reveal unaffected tissue underneath. This is generally many doctors' first choice of treatments, since it is conservative and causes very little tissue damage or pain. Unfortunately, repeated treatments may be needed, should the entire wart not be removed the first time.

Other treatments include:

• Injection of medication: A doctor may choose to inject the wart with a drug that will attack the virus. Bleomycin and interferon-alpha have been used with success in these applications.
• Surgical procedures: Your podiatric physician may choose to use a technique that involves cutting away the wart via a process called electrodesiccation and curettage, which uses an electric needle. Some patients find this procedure painful, and scarring can result; however, it is an effective form of treatment that often results in long-term wart removal. Note: Do not try to cut anything you suspect to be a wart off of your own skin. This is extremely dangerous and can lead to infection and scarring, among other problems.
• Laser surgery: There are two procedures for laser wart removal; your podiatric physician can decide which is best. One type of laser cuts away the growth; another cauterizes the blood vessels that feed it so that the wart dies and falls away on its own. Laser surgery may also be painful and may require a longer healing time.
• Chemical removal. Your podiatrist may choose to use one or more chemicals to remove the wart.