Plantar Warts

At Orangeville Foot Clinic, we treat plantar warts to relieve pain, limit spread, and lower recurrence. Because response varies, there’s no single “gold standard”. Some warts clear quickly; others persist despite care. We tailor plans to your age, number/size/location of lesions, health status, and comfort level.

Contagious: Warts spread by direct contact and indirectly via floors, towels, socks, shoes, and tools. Professional care helps prevent transmission and complications.

If you’re skimming, jump to the Treatments section of our guide for options, side effects, prognosis, and costs.

Key Facts

• Cause & entry: Plantar warts (verruca pedis) are HPV infections of the outer skin. The virus enters through tiny cuts or softened (macerated) skin—common in pools, gyms, showers, and locker rooms.

• Where it lives: HPV settles in basal skin cells and evades immune detection. As skin sheds, viral particles disperse and can seed new sites.

• Moisture matters: Sweaty feet help warts persist. Drying measures (breathable footwear, moisture-control products like aluminum chloride when appropriate) can help.

• Who gets them: Peak in school-age children, teens, and young adults (more communal exposure). Reduced immunity increases risk and resistance to treatment.

• Natural history: Children often clear warts spontaneously; adults—especially older adults—tend to have more stubborn lesions. Long-standing warts (6–24+ months) are harder to treat.

• Incubation: Onset is delayed—often 4–20 months after exposure—so most people can’t pinpoint when they got infected.

• Benign, but watch: Plantar warts are usually harmless. Seek assessment for lesions that change quickly, bleed, look unusual, or resist treatment—especially if you have diabetes, poor circulation, or are immunosuppressed.

How They Look (vs. Corns)

• Black dots: thrombosed capillaries (“seeds”)—a strong clue for warts (not always present).

• Skin lines: normal dermatoglyphics are interrupted over warts; corns usually keep skin lines.

• Texture & height: rough/lobulated; can be flat in weight-bearing areas (pressure pushes them inward).

• Borders: sharply defined; often with overlying callus on heels/forefoot/toe tips.

• Pain test: side-to-side squeeze hurts warts; direct top pressure hurts corns.

• Distribution: solitary, multiple, or mosaic (confluent plaques)—mosaic warts are thicker, broader, and more treatment-resistant.

Risk Factors

• Prior warts

• Barefoot exposure in communal wet areas

• Hyperhidrosis (sweaty feet)

• Shared personal items (towels, socks, nail tools)

• Reduced immunity or certain medications

Practical Prevention

• Wear sandals in communal showers/pool decks.

• Keep lesions covered (tape/dressing or “verruca socks”).

• Don’t pick, shave, or file warts at home; avoid nail-biting near nail-area lesions.

• Wash items that touch the wart (socks/towels/tools) in hot, soapy water.

• Clean showers/tubs after use.

Bottom line: Warts are common, contagious, and variable. Smart precautions reduce spread, and a tailored plan improves clearance while minimizing discomfort.

Treatments—Setting Expectations

Success varies by person and wart duration, size, and location. We discuss options, expected timelines, discomfort levels, aftercare, and costs. Many cases need multiple sessions. Options include supportive paring/debridement, topical acids, cryotherapy, cantharidin, microwave therapy, needling (Falknor’s), laser, and (for recalcitrant cases) surgical or chemotherapeutic approaches. Children may clear with conservative care; long-standing adult lesions often need more active management.

1. Occlusion (Duct Tape Method)

There is no strong evidence suggesting that simply covering a wart will cure it, so this is not considered a primary treatment. However, some research suggests that occlusion therapy (covering the wart with tape) may help as a complementary approachalongside other treatments.

Advantages:

• May reduce the risk of spreading warts to other areas.
• Low-cost and painless.
• May enhance the effectiveness of other treatments.

Disadvantages:

• Some people may experience skin irritation or allergic reactions to adhesive tape.

2. Salicylic Acid (and Other Acid-Based Treatments like Trichloroacetic Acid)

This treatment works by gradually peeling away the wart’s outer layers. Since HPV thrives in keratinocytes (skin cells full of keratin), this process helps expose the virus to the immune system.

Advantages:

• Affordable and accessible for at-home use.
• Generally painless, unless the skin reacts with irritation, contact dermatitis, or blistering.

Disadvantages:

• Low success rate (~39%) and may take weeks to months to see results.
• Requires consistent application and regular wart debridement (paring) at the clinic.
• Not recommended for:
  • Patients with diabetes, peripheral neuropathy, or poor circulation (due to the risk of causing a wound).
  • Pregnant individuals and children under 12 (lower success rate).

Application Tips for Best Results:

1. Soak the affected area in warm water for 5-10 minutes.
2. Dry thoroughly, then use a file, emery board, or pumice stone to gently remove excess thickened skin.
3. Apply the acid treatment, ensuring you avoid healthy skin.
4. Use non-porous tape (like duct tape) to cover the treated area for better absorption.
5. To protect surrounding healthy skin, consider applying a barrier like nail polish or a thin layer of petroleum jelly.

Patient compliance is key—daily application is required for weeks or months to see improvement.

3. Cryotherapy (Freezing the Wart with Liquid Nitrogen)

Cryotherapy is one of the most commonly used clinical wart treatments, where liquid nitrogen (-196°C) is applied to freeze and destroy wart tissue. Some studies suggest that cryotherapy may work by stimulating an immune response, helping the body clear the virus.

Advantages:

• Moderate success rate (~50%) for wart resolution.
• Can be effective for HPV Type 1 warts.
• Relatively low cost compared to some advanced treatments.

Disadvantages:

• Painful during and after treatment—pain levels vary between patients.
• Less effective on plantar warts compared to warts on the hands.
• Multiple clinic visits required (every 2-3 weeks for up to 3 months).
• May cause scarring, blistering, or irritation of surrounding skin.
• Requires regular wart debridement (paring) in the clinic.
• Not recommended for:
  • Patients with poor circulation, Raynaud’s disease, or peripheral neuropathy.
  • Young children, as pain levels can be unpredictable.

Double-Freeze Therapy: Some practitioners use an intensified freezing technique—freezing until a 1-2mm ice halo forms, allowing it to fully thaw, and then freezing again. This approach may increase effectiveness, but it can be significantly more painful.

Cryotherapy should be avoided on:

• The nail matrix (risk of damaging nail growth).
• Superficial nerves (such as the sides of the toes).
• Bony prominences, where healing may be compromised.

Important Note:
While liquid nitrogen (-196°C) is effective, over-the-counter wart freezing products (like Verruca Freeze) only reach around -70°Cand are significantly less effective.

4. Cantharidin (Canthacur) – The Blistering Treatment (cantharides “κανθαρίδες” in Greek means beetle)

How Does It Work?

• Once applied, the wart remains painless at first, but a blister typically forms within 24-48 hours.
• Some patients may experience early onset pain, especially on weight-bearing areas.
• In some cases, a blood blister (dark-colored blister) may develop—this is normal and part of the healing process.

Is Cantharidin Effective?
Several systematic reviews suggest that topical cantharidin can be highly effective, particularly when combined with Podophyllin and Salicylic Acid (available as Canthacur Plus or Canthacur PS). These formulations enhance wart clearance rates and may be more potent than standard cantharidin alone.

Application & Considerations

• Painless during application, making it a good option for pediatric patients.
• Pain may occur 2-4 days after application, and severity varies based on pain tolerance and body reaction.
• Some practitioners use nonporous occlusion (taping the wart after application) to increase effectiveness.
• In some cases, Cantharidin is used for periungual (under-nail) warts, as it can spread beneath the nail fold.

Advantages:

Relatively low cost compared to other in-clinic treatments.
Success rate up to 80% (higher when combined with other agents).
Painless during application—ideal for children.
Minimal risk of scarring, unlike some surgical or laser treatments.

Disadvantages:

Requires multiple clinic visits (every 1-4 weeks until wart resolution).
Not recommended for patients with diabetes, neuropathy, or poor circulation, as blistering could lead to complications.
Pain levels can be unpredictable, and discomfort typically increases after a few days.
Blistering effect may be uncomfortable, especially on weight-bearing areas.

Fun Fact: In its natural form, cantharidin is secreted by male blister beetles and given to female beetles as a mating gift. The female then coats her eggs with it as a defense mechanism against predators. Nature’s way of wart treatment!

5. Microwave Therapy for Wart Treatment

How Does Microwave Therapy Work?

• The applicator tip is single-use, reducing the risk of cross-contamination.
• Microwaves penetrate up to 3mm into the skin, targeting wart-infected tissue while minimizing damage to surrounding areas.
• The treatment is designed to stimulate the immune system, helping the body recognize and eliminate the wart virus.

How Does It Compare to Other Treatments?

• Unlike cryotherapy (freezing), microwave therapy does not cause blistering or post-treatment tenderness.
• Unlike laser therapy, microwave treatment does not generate smoke or airborne debris, reducing potential risks to practitioners and patients.
• Microwave therapy can be painful during the session, but most patients experience no pain after the procedure and can resume normal activities immediately.

What to Expect During Treatment

• One session per month for 3-5 months, depending on the size and type of the lesions.

• Each wart receives three short pulses of microwave energy, lasting only a few seconds each.

• Power settings are adjusted based on the depth of the wart, ensuring targeted energy delivery.

• Patients must stop using topical wart treatments at least 2 weeks before therapy, as they can increase sensitivity and discomfort during the procedure.

Advantages:

Precise & controlled energy delivery—minimizes damage to surrounding tissue.
No need for aftercare—patients can resume normal activities right away.
No blistering or open wounds—reduces infection risk.
Single-use applicator tips—eliminates cross-contamination concerns.

Disadvantages:

Higher cost compared to cryotherapy and some other treatments.
Painful during treatment—but discomfort subsides immediately afterward.
Multiple sessions required—typically 3-5 treatments over several months.

Key Takeaway: Microwave therapy is a non-invasive, controlled heat-based wart treatment that may be suitable for patients looking to avoid blistering and prolonged recovery times.

6. Needling (Falknor’s Technique) – Immune Stimulation for Wart Treatment

How Does Needling Work?

• The procedure involves multiple needle punctures directly into the wart under local anesthesia.
• The goal is to stimulate an immune response by introducing the virus into deeper layers of skin, where the immune system can better detect and eliminate HPV.
• In some cases, treating the largest or “mother wart” may trigger the body to clear other warts, even in remote locations.

How Effective Is It?

• One study reported a 69% success rate, while other research suggests higher effectiveness in certain patient groups.
• Success rates may vary depending on immune response, wart duration, and individual patient factors.

Important Post-Treatment Consideration

• Avoid NSAIDs (e.g., Advil, Aspirin, Naproxen) for 48 hours after treatment.
  • Why? These medications are anti-inflammatory, and we want the body’s inflammatory response to be activated—this is key to triggering an effective immune attack on the wart virus.

Advantages:

Good success rate—works by enhancing natural immune defense.
Can be performed in a single treatment session, with one or two follow-up appointments (at 1 week and 3 months).
Minimal post-treatment pain for most patients.
May help clear other warts in the body by stimulating a systemic immune response.

Disadvantages:

The numbing injection can be painful.
Risk of infection or bleeding if the technique is not performed properly.
Not suitable for all patients—especially those with bleeding disorders or immune suppression.

Key Takeaway: Needling is a simple, immune-boosting treatment that may be a good option for stubborn plantar warts, especially for patients looking to avoid prolonged topical treatments.

7. Laser Therapy for Wart Treatment

Laser therapy is another treatment option for stubborn or recurrent warts. Different types of lasers can be used depending on the size, depth, and resistance of the wart.

Types of Lasers Used in Wart Treatment:

• Nd:YAG Laser – Targets and destroys wart tissue by burning infected skin cells. Some studies suggest a high success rate (up to 96%), but results vary.
• Low-Heat Laser – Gradually raises the temperature of the wart tissue to a tolerated level (~50°C), causing viral destruction over multiple sessions.
• CO₂ Laser – Used for resistant warts by vaporizing infected tissue. However, this method may cause pain, scarring, and requires multiple sessions. Additionally, smoke generated during treatment contains viral particles, requiring proper ventilation to reduce health risks.

Considerations for Laser Treatment:

• Pain levels vary—some lasers cause discomfort during and after treatment.
• Not all clinics offer laser therapy due to equipment availability and cost.
• Can be costly and may require multiple sessions.

Key Takeaway: Laser therapy is an option for patients with persistent warts, but it’s not always the first-line treatment due to cost, discomfort, and availability.

8. Excision (Surgical Curettage) – A Last Resort

Surgical excision (curettage) is typically reserved for stubborn warts that do not respond to other treatments. The procedure involves cutting out the wart under local anesthesia.

How Effective Is It?

• Success rate ranges from 65-94%, but recurrence is possible (up to 33%).
• Typically requires only one treatment per site, unless new warts develop.

Potential Risks & Considerations:
Painful, especially on weight-bearing areas (e.g., soles of the feet).
Risk of scarring, which may lead to chronic pain when walking.
Post-surgical risks include infection, bleeding, and wart recurrence.

Key Takeaway: While excision is a fast way to remove a wart, it is usually only recommended when other treatments fail, especially for deep plantar warts.

9. Cauterization – Heat Destruction of Warts

Cauterization is a technique that uses heat or electrocautery to destroy wart tissue.

Things to Consider:

• Painful during and after the procedure.
• May cause scarring and requires local anesthesia.
• Smoke generated from burned tissue contains viral particles, requiring proper ventilation to prevent exposure.
• Often requires multiple treatments, especially for larger lesions.

Key Takeaway: Cauterization is less commonly used today due to its pain, healing time, and potential for scarring. It is not offered in all clinics, including ours.

10. Bleomycin – Chemotherapy for Resistant Warts

Bleomycin is a chemotherapeutic agent that can be injected directly into resistant warts. It is not recommended for regular warts and is typically reserved for cases that have failed multiple other treatments.

How Effective Is It?

• One study reported an 87% success rate in patients with recalcitrant warts, with only 20% needing a second injection.
• Precise injection is required to avoid damage to surrounding healthy tissues.

Advantages:
High success rate in resistant cases.
Typically requires only 1 or 2 injections.
No evidence of systemic toxicity when used correctly.

Disadvantages:
Very painful during injection, requiring local anesthesia.
Can cause skin damage, resulting in black eschar (dead skin) that needs removal within 2-3 weeks.
Possible temporary nail loss or permanent nail deformity if injected too close to the nail.

Note for Practitioners:

• Bleomycin (0.25-1 mg/ml) is injected up to 3 times, with a maximum total dose of 4 mg over two sessions.
• Successful injection is confirmed by blanching (whitening) of the lesion.

Key Takeaway: Bleomycin is not a first-line treatment but can be effective for difficult-to-treat warts. However, due to pain and risks, it is reserved for severe cases.

11. 5-Fluorouracil (5-FU, Efudex Cream) – A Chemotherapeutic Approach

5-Fluorouracil (5-FU) is a chemotherapeutic agent that has been used as an off-label treatment for stubborn warts. It works by inhibiting the growth of infected skin cells, making it a useful option for resistant plantar warts.

How Is 5-FU Used?

• Topical application: Patients apply 5% 5-FU cream/solution to the lesion twice daily and cover it with tape for one month.
• Combination therapy: One study found that combining 5% 5-FU with 10% salicylic acid increased success rates to 63%, compared to 23% for salicylic acid alone.
• Intralesional injection: 5-FU (40 mg/ml) can be injected weekly for up to 4 weeks, with studies reporting up to 60% efficacy.

Advantages:
Relatively inexpensive compared to other advanced treatments.
Few office visits required—mainly for paring (debridement) of the wart.
High success rates—some studies show up to 95% effectiveness in certain cases.
Generally painless—especially for topical application.

Disadvantages:
May cause blistering, irritation, or mild pain after application.
If used near the nail, it may cause nail detachment—not recommended for periungual (around-the-nail) warts.
Potential for mild-to-moderate ulceration.
Contraindicated in pregnancy and breastfeeding—should not be used in these groups.

Key Takeaway: 5-FU is an effective option for resistant warts but should be used cautiously, especially near nails or in sensitive areas.

12. Imiquimod (Aldara) – An Immune-Boosting Topical Treatment

Imiquimod (Aldara 5% cream) is an immune response modifier commonly used for genital warts, but studies suggest it may also be effective for plantar warts. This medication stimulates cytokines, helping the body’s immune system recognize and fight the wart virus.

How Is It Used?

• After wart debridement (paring), imiquimod is applied directly to the lesion.
• Different protocols exist:
  • Some protocols suggest applying it twice daily for up to 24 weeks.
  • Others recommend three times per week for plantar warts.
• Can be combined with occlusion (duct tape) or salicylic acid for better results.

Advantages:
Painless—a major advantage over many wart treatments.
Good success rate—especially in patients with weakened immune systems.
Low recurrence rate—helps train the immune system to prevent future warts.
Self-applied by adults—reducing the need for frequent office visits.

Disadvantages:
Expensive—one of the costlier wart treatment options.
Long treatment plan—may take several months to show results.
Possible local skin reactions—including redness, inflammation, or mild pain.

Key Takeaway: Imiquimod is a promising option for plantar warts, particularly in patients with immune system challenges, but it requires long-term commitment and patience.

13. Zinc and Vitamin A – Immune Support for Wart Clearance

Zinc and vitamin A are sometimes recommended as complementary treatments for warts due to their mild immune-boosting effects. However, there is no strong scientific evidence that taking zinc or vitamin A alone will cure warts.

How Are They Used?

• Suggested regimen:
  • 15mg zinc tablets
  • 10,000 IU of vitamin A
  • Taken twice daily for 30 days

Advantages:
Safe for most individuals, with minimal risk of side effects.
Can improve skin turnover, which may help speed up wart clearance.
Widely available over-the-counter—no prescription needed.

Disadvantages:
Not a standalone treatment—should be used only as a complement to other wart therapies.
Effectiveness varies significantly between individuals.

Key Takeaway: Zinc and vitamin A supplementation may provide some immune support, but they should not be relied upon as a primary wart treatment.

Want to Book an Appointment?

If you’d like to discuss the best wart treatment options for your specific case, our clinic is happy to help!

Call us at: 519-942-4705
Have questions or want to send pictures of your warts? Message us HERE.