War on Warts

Are you geared up to put on those summer sandals, but afraid to reveal your heinous tootsies? Don’t worry. With time and patience, you should be able to banish those warts from your feet for good.

Your best strategy? Stick to your wart treatment regimen to help ensure victory, and take care not to push your doctor to just cut or burn the warts off — since that may leave you with a bigger problem than the warts ever were.

The Enemy
Plantar warts — and many warts — are caused by the human papilloma virus (HPV). There are dozens of different HPV types, each with a predilection for a certain body part(s). For plantar warts the enemy is HPV type 1. Other HPV types cause genital warts — types 6 and 11 — while still others are associated with cervical cancer, including types 16 and 18.

Are plantar warts contagious? You bet.

Warts are spread by:

  • skin-to-skin contact with another person who has a wart
  • auto-inoculation (spread to other parts of the body by touch)
  • contact with HPV on an inanimate object

HPV infects the skin and causes the changes you see as warts. Plantar warts show up as small bumps on the bottom and sides of the feet and toes. The warts usually have a rough surface, and tiny black dots can often be seen inside the wart itself. The black dots are actually small blood vessels, and their presence helps make the diagnosis of a wart versus a wart look-alike.

Two common wart look-alikes are:

  • Corns — These are small cone-shaped bumps that point into the skin. They have a central plug and lack the tiny black dots of plantar warts.
  • Calluses — These are large areas of skin thickening due to long-term friction.  Calluses retain normal skin markings (toes and feet have normal prints just like fingers and hands) while warts lose their normal skin markings.

You may have just one plantar wart or dozens of them. Often the warts group themselves together to form plaques. Plantar warts can grow inward from the pressure of standing and walking, and often hurt.

Sometimes it’s difficult to tell a wart from a callus. That’s because it is common for a callus to form over a plantar wart. It may take paring (removing layers) of the callus to find the telltale wart below.

You may have other warts on your hands, knees or elbows, which are all common wart sites. Warts love areas of friction and skin trauma.

Strategic Planning
Before embarking upon treatment you will have to decide if you want to do battle at all, since most warts eventually go away on their own.

More than likely you abhor the warts and want them off yesterday. That leads to the common request to just cut or burn the things off, no matter what the potential for pain or scarring.

That request is usually borne out of frustration and should be countered with the golden rule of wart treatment: Don’t let the treatment be worse than the wart itself. Having a wart may be far better than having a painful scar that you have to walk on every day.

Here are your weapons against plantar warts, and the pros and cons of each. The fact that there are so many different treatments tells you that none is perfect.

If you have only one or two warts that don’t bother you, then it’s perfectly OK to let the warts go away on their own.

  • Pros — No pain or scarring will result.
  • Cons — The warts may spread while you are waiting for them to retreat.

Home treatment with topical salicylic acid
Over-the-counter salicylic acid products for plantar warts abound. These are generally stick-on discs or patches that fit over the wart and are left in place for a specified amount of time (e.g., two days). The salicylic acid gets released from the disc or patch and slowly eats away at the wart. The dead skin should be filed off and a new disc or patch applied according to the schedule on the package insert.

No one product is clearly superior to the others. Be sure to read the package insert carefully before using the medication.

  • Pros  This is a great method of treatment since it is convenient, non-traumatic and puts you in control.
  • Cons  Motivation is key, since it may take many weeks for the warts to go away. The salicylic acid can cause local skin irritation.

Office Treatments
These are designed to destroy the wart-infected skin and allow new, uninfected skin to grow back in its place.

Paring — This is when the doctor uses a scalpel blade to shave off layers of a wart and any overlying callus. It can be followed by freezing with liquid nitrogen and/or home salicylic acid treatment.

Blunt dissection — The wart core is bluntly dissected out.

Chemical injections — Chemotherapeutic agents are sometimes injected into stubborn warts. These injections can be painful and expensive.

Cryotherapy — The plantar warts are frozen with liquid nitrogen. This can produce a good result, but treatment is painful and can lead to blister formation and scarring.

Surgical destruction — Destructive surgery may get rid of the wart but can leave a painful scar that is worse than the wart itself. Beware of any treatment like this.

Laser treatment — The warts are zapped with a pulsed-dye laser or, for large, difficult-to-eradicate warts, a carbon dioxide laser.

  • Pros — All of these methods can be effective.
  • Cons — The risk of pain and scarring can be great with over-zealous cryotherapy or with surgical or laser destruction. These methods must be thoroughly discussed with your doctor before treatment is undertaken. The treatments can also be costly and require time out of your schedule to go to the doctor.

The Battle
Once you’ve decided to actively eradicate the warts, you should stick to the battle plan. People often get frustrated that their warts haven’t gone away after a few days of a treatment regimen like topical salicylic acid.

If you are undergoing office treatments, make sure to show up to all the appointments, since each missed appointment gives the warts that much more time to regroup and re-emerge.

It’s also important to have proper footwear. Since plantar warts occur in areas of pressure and friction, these problems need to be minimized by wearing good-fitting shoes and sneakers.

The Aftermath
After the wart has been treated, you should be cautious in your celebration. That’s because new warts may have been forming all along and may just be coming out of the trenches. And those warts that seemed to have succumbed to treatment may just decide to recur in the same place weeks to months later.

Try not to let discouragement reign, since the nature of plantar warts is to be tough little opponents. If you plan your strategy, understand your weapons, and muster up a lot of patience, it’s very likely that you will prevail.

As with all treatments, if these regimens don’t work for you, make sure to see a specialist.


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