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Dr. Foot Solutions - Monday, September 16, 2019
Verrucae Pedis (the foot), also known as plantar warts - which technically means they’re on the sole of the foot (plantar surface).

School holidays are often a time when a lot of kids seem to present with warts. Parents often think that they may have picked them up running around barefoot, particularly at swimming pools, which may or may not be the case, as like a lot of medical things, we just don’t know why some pick up the virus and others don’t.


Warts are a viral infection affecting the top layer of the skin, much like the flu is a viral infection. Often people are not aware of their presence until they grow in size. They can be either painless or painful. Usually they only become painful once they get to a reasonable size, but it varies from one person to the next, according to pain sensitivity and location of the wart. The bigger the wart, the more it feels like a foreign body. The parents of an 8 year old patient seen today weren’t sure, thinking that it may have been a bindii, as he had walking on grass.

The classic presentation of warts is that they have a ring-like appearance around them, because warts are encapsulated – think of the fence around a football oval.  The second important feature is that the skin lines, as in finger print lines, do not pass through the wart tissue. Thirdly, they are very vascular with lots of blood capillaries being present. These often show as little black spots within the wart. They can be painful when pinched from one side to the other, and that certainly can be the case with bigger warts, but this is not always the case. They can also be sore when pressed over the top of the wart, particularly when it is in a weight bearing area of the foot, such as the ball or heel.

Warts aren’t often painful when in non weight bearing areas, such as the arch or behind the pads of the toes (toe sulcus).

Podiatrists and other health professionals generally only recommend treating warts if they have become painful or if they are increasing in size to the point of becoming a problem. Recently I saw one patient who had a wart which was present for over 10 years under the centre of the heel and had grown to the size of a 10 cent coin, but it was covered with very hard compacted callous (kerototic) tissue. The callous tissue really had become a problem. The wart acts like a foreign body, stimulating the body’s protective mechanism to build callous over the lump. Differential diagnosis, especially in weight bearing areas, not only includes corns but also other unusual skin lesions, though the latter are uncommon.

A good way of checking is to carefully debride the top surface (paire the top away) of the wart. A podiatrist or other health professional will often do this very easily in their room, usually pain free. If spotting bleeding occurs, it is generally a good diagnostic indicator of a wart, because the blood capillaries trapped within the wart tissue then bleed when they’ve been gently paired down. Another telltale is to look for the absence of skin lines. If it is a weight bearing area, there would generally be skin lines, as in your finger print, particularly if it is the ball and heel of the foot. These do not continue through wart tissue, so once the top layer or any callous tissue is scraped down, then it is much easier to see if there is a continuation of these line through the lesion/lump. In particular, the application of some sort of oil e.g. tea tree or olive oil on the skin with a cotton bud will show up the lines more readily (see photo attached, which was taken after the top surface had been debrided off the 8 year old’s wart).

How quickly do warts grow?

I’ve seen patients who have had them come up very quickly in the space of 4-8 weeks, up to 5mm and sometimes bigger surface area.

How quickly do they take to respond to treatment?

It varies. The general principles of treatment aim to destroy wart tissue, either by chemical (paste, liquid etc) or thermal (heat or cold). Surgery (curettage) can be performed on some warts by an experienced surgeon but is to be avoided as it generally results in a permanent scar instead of a transient temporary wart. We mostly only see these scars in old, ‘historic’ cases where surgery was performed.

The general principle, if they’re painful or in a weight bearing area, is to carry out a treatment that doesn’t cause irritation and pain to the patient. A classic one that I use for warts that have failed other treatments elsewhere, is to use diluted formalin (10% solutions), because the chances of creating pain or irritation of the surrounding skin is very low. This has always been effective on recalcitrant warts. Even some of the over the counter wart treatments can contain podophyllum, which can be an irritant to the skin. It is also worth remembering not to panic if the wart does get a bit irritated, or looks slightly infected, because generally that is the final stage of resolution of the wart. Caustic treatment or thermal treatment is actually aimed at destroying the wart, but it is very hard to totally isolate the treatment from the normal, healthy skin surrounding the wart. The other point to keep in mind is that any irritation of the area could lead to an infection, but result in the area liquefying, in which case resolution of the wart can occur naturally.

There is a school of thought that boosting the body’s immune system with oral supplements and essential oils can assist, or likewise, a combination of essential oils applied topically can assist in removal of warts. Banana skin is another ‘favourite’, and can be sore potent that is has been known to inflame the surrounding skin.  

Natural methods can also be employed. In one case, the child patient is asked to focus on the idea of the wart disappearing. Historically, some GPs would give children a shilling for their wart. So long as the person actively thinks that their wart is going, there are instances where that has actually worked. Other forms of treatment that involved not using chemical or thermal treatment include covering the area with a waterproof tape to keep air out. It is not so much to keep water off it, but to keep the air out. Continually applying even ordinary zinc oxide sticking plaster can assist, but a true waterproof one excludes the air totally. When left in place for a few days and then replaced, even as the tape is pulled off, some of the wart tissue will often pull away. Offloading offload any foot pressure, if it’s on the top of sides of the foot, or weight bearing pressure under the foot, if it’s in a weight bearing area, will make the area more comfortable and generally faster to expedite, in other treatment. If the wart is not being pushed back into the skin, particularly when that results in kerototic tissue overlaying the wart, which is tough and any treatment has to penetrate through that.

Above all, it is worth remembering warts rarely become malignant, are not highly infectious, and usually ‘self limited’ - can disappear without treatment. Treatment is generally recommended if the area becomes painful, growing in a size that becomes a problem or developing multiple warts in a cluster (‘mosaic’ warts).

Bronwyn Cooper

Rehabilitation Podiatrist

Consultant in Chronic Pain and Footgear

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