Plantar Warts Are A Pain In The Neck

Plantar Warts Are A Pain In The Neck
October 7, 2019

Ask any practitioner, and most say that treating warts can be frustrating for the practitioner and the patient. Why? This is because whatever treatment method is used, there is a chance of failures and recurrences.

I highly suggest patients with plantar warts read this post thoroughly, but if you don’t have time or interest, at least read the available treatments at the end of this article. This is crucial for patients to understand the different types of therapy, adverse effects, expected outcome (prognosis) and cost.

In chiropody/podiatry settings, we see patients with plantar warts daily. But not all warts are easy to treat, especially if the wart has been there for more than two years. Warts are usually harmless and can disappear without treatment within the first few months. But they can also cause discomfort, pain, and cosmetic concerns. After all, this wart is an infection and needs to be treated.

Plantar wart (verruca pedis) is a skin infection caused by Human Papillomavirus (HPV) and passes between people through direct contact with the viral particles (skin-to-skin contact), but can also be transmitted by indirect contact such as walking barefoot on contaminated surfaces (public areas including locker rooms, shower, gym, etc.), socks, shoes, towels and sports equipment. Some activities, such as picking at warts with fingernails or objects such as nail clippers or pumice stones, can also result in the transference of infection to hands or other parts of the body. Patients should be encouraged to wear proper foot coverings like shower
shoes or sandals when walking on possibly contaminated surfaces in public areas
to avoid any direct skin contact. Any item that comes into contact with a wart
should be thoroughly washed with hot water and soap. If you have a plantar wart, it is a good idea to cover it with tape or “verruca socks” and poolside sandals if you go to public areas such as a swimming pool. Moreover, simple domestic hygiene, such as cleaning the baths or showers after use and avoiding shared towels or socks, is essential to reduce the risk of cross-contamination. If the wart is under or around the nails, biting the nails must be avoided, or the virus can easily cause oral wart infection.

It has been reported that Human papillomavirus can survive months to years on surfaces. The incidence increases during the school years to peaks in adolescence and early adulthood. There are over 150 types of HPV viruses (distinguished based on their DNA), of which only a few can cause plantar warts (and some other ones can cause genital, oral or anal warts). Each of these viruses behaves differently to some degree, and they have different preferred sites of infection. For instance, HPV-1 replicates in more keratinized skin areas such as palms and soles, while HPV-16 prefers the genital region.

To have the plantar wart, there should be some degree of skin impairment, such as abrasion, cut or maceration (too much moisture), so the virus can enter the skin and reach the stem cells at the basal membrane of the skin. That explains why swimming pools and shower rooms are a hotspot for getting plantar warts as the skin becomes softer in contact with water, and just a tiny hole can be a portal of entry for the virus. In addition, as the skin cells shed, viral particles are released and can be transmitted to surfaces where the virus will remain until picked up by a new host or spread to adjacent sites. That is why covering the wart(s) with a band-aid (or duct tape) is a good idea to prevent its spread.

Warts prefer a moist environment. Since warts are more likely to survive on sweaty feet, part of the treatment plan should be drying out the skin (with topicals such as Foot Fresh or Drysol).

Warts at the bottom of the feet (plantar warts) are usually more refractory to the treatment than typical warts and often grow inward. Moreover, HPV can survive by evading the host’s immune surveillance. Hence, different therapies and modalities are available to fight the battle against these sneaky viruses. However, none of these treatments is a panacea (there is no guarantee in medical treatments anyway). Also, we should remember that the number of wart lesions does not affect the treatment outcome (prognosis).

I call these viruses sneaky because most people do not know how they got the virus, but the virus finds its way and resides inside the infected cells, sometimes for years. The viruses live as parasites and introduce their DNA into the normal skin cells to reproduce themselves and also be able to hide from the human immune system. That is why the wart is expected to survive more than six months because it knows how to protect itself from the immune system. That explains the challenge in treating warts and why immune-compromised people have massive and usually resistant warts.

There is a clinical impression that warts in adults, especially in elderlies, are slower to clear with or without treatment. There are reports that warts are more likely to spontaneously disappear in children younger than 12 years old.

Some literature also categorizes the wart lesion as a benign tumour because of the similar mechanism of an uncontrolled increase in cell growth and reproduction. That explains why some anti-cancer medications, such as Bleomycin and Fluorouracil (5FU), are used for wart viruses. Some types of warts, mainly genital warts, can transform into cancer, but this is extremely rare in the foot. However, if you see a wart similar to the image below, don’t wait; see your physician or chiropodist immediately.

vp carcinoma
verrucous carcinoma

How long is the incubation time?

You may wonder how warts will show up long after the first contact. The answer is unclear, but we know it ranges from a few weeks to more than a year! (4 weeks to 20 months).

What does a wart look like? How can we distinguish it from corn?

Warts can manifest differently depending on the location, age, the subtype of the virus, the patient’s immune system etc. There are several clinical manifestations of the lesions, but we should remember that not every wart has all of the following criteria:

  1. Black dots (present or not) (this one is diagnostic for warts)
  2. Impaired skin lines (dermatoglyphics) in the lesion (checked better with dermoscopy)
  1. Arrangement (single or confluent)
  2. Level (Raised or flat)
  3. Aspect (Rough/lobed or smooth/not lobed)
  4. Border (usually sharply defined)
  5. White skin flakes (present or not)
  6. Colour (Yellow or red)
  7. Overlying callus (present or not present)
  8. Pain or no pain

The small black dots are widely accepted to be the end of thrombosed (clotted) capillaries (small vessels) within the lesion. If you see these black dots in a lesion, it is most likely a wart.

On the bottom of the foot, most plantar warts are beneath the pressure points, such as the ball of the foot, heels, and the tip of the toes (due to higher pressure and more possible damage to the skin). Individuals may have single or multiple lesions. Sometimes, a small cluster of warts that almost look like vesicles (small blisters) may form around a large wart, and sometimes multiple warts merge and form a larger plaque of warts called mosaic warts. These warts are sometimes the most difficult ones to treat.

What are the risk factors for Plantar Wart?

Major risk factors include having preexistent warts, being in close contact with someone with a preexistent wart, walking barefoot, hyperhidrosis (sweaty feet) and a compromised immune system.

Do all warts look similar?

There are different types of warts (based on their appearance), including common warts, plane warts, filiform or digitate warts, mosaic warts, periungual (around or under the nails) warts, Butchers’ warts (occupational handlers of meat, poultry or fish, mainly in the hands), and pigmented warts (mostly in Japanese people).

Plantar Wart Cluster
Plantar Wart Cluster

Mosaic warts: These warts are plaques formed by the merging of closely grouped small warts and are one of the most stubborn ones caused by HPV type 2. Mosaic warts can spread out and cover a large area on the bottom of the foot, particularly in immunocompromised patients.

Mosaic Wart
Mosaic Wart – Note the small black dots in the wart.

Is there any immunity or vaccine for warts?

No, there is no immunity or vaccine for plantar warts. There are vaccines for other types of HPV infections (such as genitals) but not for plantar warts. We still do not fully understand why the immune system in a healthy person cannot get rid of plantar warts. But the leading theory says that the virus hides itself and its DNA inside the skin cells (epidermal cells), which is why the immune system cannot recognize it. However, reports are showing that humoral immunity may be established by antibodies that can prevent future reinfection of that specific HPV subtype.

Are warts painful?

It can be painless or painful depending on the location, the amount of callus, and the type of wart. Many patients with plantar warts present with pain or the sensation of a pebble or swelling under their feet. But generally, pain is not a diagnostic symptom for warts.

What are the available wart treatments?

Success in wart treatment depends on multiple factors; each patient will respond differently. Therefore, the treatment should be individualized based on age, pain tolerance, commitment to the treatment, financial status, location of the wart and the duration of the infection.

Different treatment options will be explained to the patient during the first appointment, including their expected outcome, adverse effects, degrees of pain, and cost. Then based on the clinical manifestation and location of the wart, the patient’s age, expectations, pain tolerance, neural and vascular condition of the foot, and financial status, the practitioner will design a treatment plan.

Some practitioners prefer to monitor early warts in young children because these warts may spontaneously disappear within 2 years. However, not treating the wart can also allow the wart to persist longer and become more resistant. Usually, it is more difficult to treat a wart if it has been present for more than 6 months. Warts in adults are also more stubborn than in children.

Below, I listed several treatment options of which we can provide you with most of them at Orangeville Foot Clinic.

Occlusion:

No evidence-based research suggests covering warts cures them and is not suggested as the main treatment. However, covering the wart with adhesive or duct tape may be considered a complementary remedy.

Advantages: Covering the wart can reduce the risk of spreading. Low cost. No pain. Increases the efficacy of the main course of treatment.

Disadvantages: Skin reaction to the adhesive.

Salicylic Acid (and other types of acid treatments such as trichloroacetic acid):

It works by removing the keratin (outer layer of the skin) surface. Remember, warts hide in keratinocytes (cells full of keratin) and use them as a source of nutrition.

Advantages: Usually pain-free during and after treatment unless the skin reacts, leading to contact dermatitis or blistering. Low cost. Safe to use at home.

Disadvantages: Low success rate (39%). Takes weeks to months of daily applications, along with regular pairing (debridement) of the wart in the clinic. Not recommended for certain patients, including patients with diabetes, peripheral neuropathy, and poor circulation, as the acid can cause a wound. Prolonged treatment is not recommended in children and pregnancy. The lower success rate in children younger than 12y.

Before applying the acid, some suggest soaking in warm water for 5-10 minutes, then drying the area before using a file, emery board or pumice stone to remove the thickness of the lesion. Then apply the acid with occlusion by duct tape of a bandage.

Patient compliance is one of the most (and challenging) parts of this treatment regimen.

I usually suggest masking the normal skin around the wart with nail polish or cream-like polysporin before applying the acid compound.

Cryotherapy:

Freezing the wart off with liquid nitrogen is traditionally one of the most common routes of treatment in a doctor’s office. But it is not always the best choice of treatment. The overall success rate is less than 50%. Reports are saying it is less effective than Salicylic Acid. It has been said that freezing works by stimulating the immune system.

Advantages: Relatively low cost, 65% success rate on HPV type 1 (HPV-1).

Disadvantages: Painful during and after the treatment, the pain is unpredictable and variable between patients, needs several appointments in the clinic, more effective for warts on hand than feet, limited control over how deep the normal tissue under and around the wart will be damaged, requires regular wart paring (debridement), high rates of failure or recurrence, not recommended in patients with poor circulation, Raynaud’s or peripheral neuropathy. It can leave a scar and/or cause blisters. Because of the pain, this form of treatment is not recommended for young children.

Treatment is repeated every 2 to 3 weeks for up to 3 months. Double-freeze therapy is a technique in which the warts are frozen until a 1-2-mm ice halo forms, then fully thawed and immediately refrozen. This has been said to increase the efficacy of the treatment, but it can be very painful. This treatment should be avoided if the wart is on the nail matrix or superficial nerves such as the sides of the toes or over a bony prominence.

Liquid Nitrogen used for this technique should have a temperature of -196  ̊C. Over-the-counter products such as Verruca Freeze only freeze the tissue to -70  ̊C and are even less effective.

Canthacur (cantharides “κανθαρίδες” in Greek means beetle)

Hycleus lugens, a colored beetle, that secretes cantharidin and that is why this treatment is called “Beetle Juice”

This is one of the most popular wart treatment options in our office.

Medications made from blistering beetles go back to ancient times. It has been used for wart treatment since 1950. Cantharidin (Canthacur) is a vesicant (blistering) topical that lyses the keratinocytes (outer layer of skin) where the wart viruses are residing.

The blister usually occurs 24-48 hours after application, but sometimes pain starts even earlier. It can cause a blood blister (dark blister) which is normal.

Several systematic reviews and research found topical cantharidin alone led to significant clearance of warts, especially when mixed with podophyllin and salicylic acid. This mixture is available as Canthacur Plus or Canthacur PS, which is stronger than regular Cantharidin.

The application is painless, bloodless and rapid, making it suitable for pediatric use in the clinic. However, it can be quite painful during the next 2-4 days, especially in the weight-bearing areas. People experience different degrees of pain, which can be due to different pain thresholds or body reactions to the medication.

The efficacy of the treatment can be increased by covering the wart with nonporous occlusion. Some use it for warts under the nails as it can spread under the nails and into the nail fold.

Advantages: Relatively low cost, success rate up to 80%, no pain during the application, low risk of scarring.

Disadvantages: Multiple appointments in the clinic every 1-4 weeks, not recommended for patients with diabetes, neuropathy and poor circulation, unpredictable pain severity after each treatment, blister.

FUN FACT: In its natural form, cantharidin is secreted by the male blister beetle and given to the female as a copulatory gift during mating. Afterwards, the female beetle covers her eggs with it as a defence against predators.

SWIFT Machine (microwave therapy)

Swift

Microwaves have been in clinical use for over 30 years, and it has been proven that they cannot cause any damage to the DNA of living things. The microwaves that are emitted from the SWIFT machine can generate heat in a limited and focused area on the skin.

The applicator tip of the device that contacts the skin is single-use to eliminate the risk of cross-contamination. Microwave treatment has some advantages over cryotherapy (freezing with liquid nitrogen). For example, the microwave travels in highly controlled and precise straight lines aligned with the device tip, so the heat spread or damage to the adjacent tissues is minimal. Both treatments are painful during the treatment, but unlike cryotherapy, there is usually no blistering or tenderness after SWIFT treatment. However, SWIFT treatment is more expensive. One advantage of this treatment compared to LASER is that SWIFT does not generate smoke or particulate debris, which can potentially be risky for the practitioner or the patient.

There is no pain after SWIFT treatment, and the patient can have regular activity after each treatment. The patient needs one treatment per month for 3-5 months, depending on the size and type of the lesions. During the treatment, we set the power of the microwave up to 10 watts, which gives us about 3mm penetration of the heat. Each treatment normally consists of three wart applications lasting for only 2 seconds. We ask patients to stop using topically on warts at least two weeks before the treatment as it will significantly increase the pain during the treatment.

For more information, please visit the SWIFT company’s website by clicking HERE.

Needling (Falknor’s Technique):

The needling technique has been considered somewhat of a renaissance in chiropody/podiatry practice for wart treatment. It was first described by Dr. Falknor, an American practitioner, in 1969, and then many podiatrists and dermatologists followed and modified his technique. This method involves multiple needle penetrations right into the wart under local anesthesia.

The idea behind this treatment is to enhance immune response and also to introduce the virus into the deeper layers of the skin, where the immune system can detect the viruses. In many cases, if we attack the main and first wart (the mother wart), other warts may be cleared, even in remote areas.

In one study, a 69% success rate was reported, but other reports show a higher success rate.

It is advised to avoid NSAIDs (Advil, Aspirin, Naproxen, etc.) for about 48 hours. These painkillers are anti-inflammatory, and we do not want to reduce the inflammation after treatment as an inflammatory response is key to triggering the immune response to wart infection.

Advantages: Good success rate, can be done in one treatment session with 1 or 2 follow-up appointments (1 week and 3 months later). After 3 months, if the wart is still present, another needling treatment may be granted. Not much pain after the treatment.

Disadvantages: Numbing the area is painful, risk of infection or bleeding if the technique is not properly done,

LASER (low or high level):

Different types of LASER can be used for treating warts. Currently, our office is not equipped with a hot LASER.

Nd:YAG LASER has up to 96% cure rate. It basically burns the cells that contain the virus. Expensive.

Low-Heat LASER: repeatedly raises the temperature of the area to a tolerated level of about 50 °C.

CO2 LASER: Used on resistant warts. It can be painful after treatment, may leave scarring, may need multiple treatments, and smoke from the burn can be hazardous if proper ventilation is not provided.

Excision (surgery) = Curettage

This method is usually a last resort for stubborn warts. It is not suitable for warts that involve large areas of the skin.

Advantages: The fastest way to eliminate the wart is usually with a 65-94% success rate. Often only needs one treatment per site.

Disadvantages: Freezing the area, especially at the bottom of the foot, is painful. Also, there is still up to a 33% chance of recurrence. If the wart is at the bottom of the foot, surgery most likely ends up with scarring, which can be permanently painful on weight-bearing. Other adverse effects (like any other surgery) include post-operation pain, bleeding, infection, and recurrence.

Cauterization:

Similar to surgery or LASER, this method is to destroy the wart lesion. It can be painful during or after treatment; the smoke-generated afterburn can be hazardous for the practitioner or patient. You may need multiple appointments with or without numbing the area for larger lesions. Our office is not equipped with this treatment.

Bleomycin:

This is a chemotherapeutic agent that can be used for wart treatment. Not recommended for regular warts and is generally reserved for resistant warts that have failed multiple other treatments. This treatment is an intralesional injection of 0.1-1.0 cc of Bleomycin and may also need local anesthesia. One study showed complete resolution of recalcitrant plantar warts in 87% of the patients, with only 20% of the patients requiring a second injection. It can cause some damage to the healthy tissues around the wart, so precise injection is required.

Advantages: No evidence of systemic toxicity, high success rate, only one or two injections,

Disadvantages: Very painful during injection (so needs local anesthesia), risk of damage to the surrounding healthy tissues, may leave black eschar on the lesion that needs debridement 2-3 weeks after injection if it does not detach spontaneously, possible nail loss (temporary) or nail deformity (permanent) if injection has done close to a nail.

Note for practitioners: Bleomycin sulphate (0.25-1 mg/ml) is injected up to 3 times to a maximum total dose of 4mg in up to 2 injection sessions with a maximum total dose of 2000 units. Injection to the wart was confirmed by observing blanching in the lesion.

5-Fu (5-Flurouracil = Efudex cream) 

This is another chemotherapeutic agent that can be used for wart treatment. It works by inhibiting the cell growth of the infected skin cells. This treatment is also reserved for resistant warts.

Patients must apply 5% cream/solution of 5-FU on the lesion twice a day and cover it with tape for a month. One study showed that a combination of 5% 5-FU and 10% salicylic acid had a 63% success rate compared with 23% when only salicylic acid was used.

It can also administer by intralesional injection of 40 mg/ml 5-FU weekly for up to 4 weeks (60% efficacy)

Advantages: Relatively inexpensive, few office visits for paring (debriding) warts, high success rate (some studies show up to 95%), generally painless

Disadvantages: Blistering, local irritation, and sometimes pain after each application. If used close to the nail, it can cause nail detachment (not recommended for warts under or around nails), can cause mild-moderate ulceration, and be contraindicated in pregnancy and breastfeeding.

Aldera imiquimod (5% cream)

This medication is topical immunomodulation that is typically used for genital warts. However, skin warts such as plantar warts have also responded to imiquimod (Aldera) treatment. It stimulates cytokines (immune system).

The treatment should be done after debriding the wart. One protocol involves applying the cream on warts twice daily for up to 24 weeks. It can be combined with occlusion (duct tape) or salicylic acid. Another protocol suggests applying the cream 3 times per week for plantar warts.

Advantages: No pain, good success rate, well-tolerated in the compromised immune system, low recurrence rate, self-applied by adults, not many office visits required.

Disadvantages: Expensive, long treatment plan, possible local skin reaction leading to inflammation or pain.

Zinc and Vitamin A:

Zinc and vitamin A are known to have a mild effect on boosting the immune system. There is no solid evidence that taking zinc and/or vitamin A alone clears warts. Still, as there are no serious side effects to them, many practitioners suggest them as a complementary treatment.

It has been suggested that taking 15mg zinc tablet and 10,000 Unit Vitamin A 2 times per day for 30 days can increase skin turnover and complement the main course of treatment. You can buy these supplements from any pharmacy without a prescription.

If you would like to book an appointment, please call us at 519-942-4705, and if you have questions or want to send pictures of your warts, please get in touch with us at contact@orangevillefootclinic.com

Some of the references:

1- Plantar Warts: Epidemiology, Pathophysiology, and Clinical Management

2- The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases

3- What are the effects of heating the skin with microwaves?

26 Comments

  1. Kay

    I read that putting 3% hydrogen peroxide was a good idea to soften the area and remove the callus on top of the verruca (definitely a verruca as there was a black dot) – I recognised it was a verruca as I had one when I was 6 or so.. so around 50 years ago.
    I religiously put the hydrogen peroxide on a little paper and taped it to my foot for a few nights. Then replaced it with just tape in the morning. The callus has now come off … and some more… I now have a rather BIG HOLE (crater?) under the ball of my foot.
    Worryingly, it is not painful.

    What now?!?!

    When you say TAPE, is there a specific type of tape? If I just use most types of tape, the area stays moist. The ball of my foot looks like it has been in a bath for the last week…

    Reply
    • orangevillefootclinic

      Hi Kay,
      Can you send us a picture of the bottom of your foot so I can see the big hole that you are referring to? You can email us at contact@orangevillefootclinic.com
      Also, if there is an active wart, I usually suggest duct tape (any duct tape) as a supplemental home remedy. But in general, covering warts with any tape or bandaid is a good idea to minimize the chance of spreading.
      Let us know if you have any further questions.
      Orangeville Foot Clinic

      Reply
  2. Caitlyn

    Excellent article! This contains the most info and best summaries of treatments that I’ve seen.

    I’ve had an issue with a plantar’s wart under my toe for a while. At home I did two courses of over the counter salicylic acid treatments, with neither of them fully removing the wart and only resulting in it worsening. Eventually it became so painful that I couldn’t walk properly. I went to a podiatrist and had needling done. The local anesthetic was incredibly painful (I typically have a high pain threshold, but almost passed out), however post the procedure the pain from the wart practically disappeared. I thought the issue had been resolved, however the wart is now growing under a layer of skin and is becoming painful again.

    Any recommendations in terms of treatments? Also, do you recommend seeing a dermatologist or a podiatrist?

    Reply
    • Ali Nasr-Esfahani

      Hi Caitlyn,
      Thank you Caitlyn for your comment. I’m glad you found our article useful.
      What area are you located in? I’m not sure about the treatment options that dermatologists can offer as it significantly varies in each area and it also entirely depends on the dermatologist’s personal interest in treating warts. However, the treatment options among chiropodists and podiatrists are generally similar and standard. If you are in Orangeville, Ontario area, I would be happy to help you. Otherwise, I recommend starting the wart treatment with Beetle Juice (Canthacur or Canthacur PS) and seeing if that works. I personally prefer to start with non-invasive treatments and if they don’t work, I try needling or surgical excision of the wart.
      Let me know if you have further questions.

      Reply
  3. Nadia

    I noticed a plantar wart cluster on the bottom of my foot when I was around age 14. I picked at it when I was younger and it spread so now I have 4 on the bottom of my foot. I’ve been using a corn remover that has salicylic acid in it and it rlly doesn’t seem to be working. I had one on my finger and I used the same method for a week and dug out the wart but it looks as if there’s still roots and the skin around it is now very sore and red

    Reply
    • Ali Nasr-Esfahani

      Hi, where are you located? You may need to switch to other treatments if the salicylic acid hasn’t worked on your warts.

      Reply
  4. pieta christodoulou

    This was an excellent article.. I am in Australia and my 24 yr old daughter has had second swift treatment. We had to stop the first session after 10 min as it was excruciating. 2 days ago we went back and they numbed her foot before the swift therapy. The after effects have been extremely painful with quite sever blood blister and bruising was wondering if this is normal.

    Reply
    • Ali Nasr-Esfahani

      Hi, sorry to see that the SWIFT treatment was too painful for your daughter. Unfortunately, SWIFT treatment is typically painful, but most people can tolerate the pain during the treatment. In rare cases, the pain may last for a longer period. If the treatment is too painful for someone, we can either reduce the power of the microwave or switch to another type of treatment. I hope your daughter has already got rid of her warts.

      Reply
  5. Beverly Yarbrough

    I have a wart on ball of my foot, I have had two cryotherapy treatments using sal.acid pads after . Did nothing but extreme pain, so I’ve had the beetle juice treatment about to have second treatment. It has been almost unbearable pain my whole foot and slightly past my ankle swelled (not sure if that normal)? My whole foot hurts and still has tingling and some weird numb like feeling to my skin. I have walked on the side of my foot and heel so I’m not sure if this is from the way I’ve been walking for a lengthy period of time but this has started since the beetle juice treatment. Still lots of pain

    Reply
    • Ali Nasr-Esfahani

      Hello Beverly,
      Thank you for your comment. I suggest that you consult with the practitioner who treated you for your reaction to the Beetle Juice treatment. Due to the prolonged and severe pain you experienced, it may be necessary to explore alternative treatment options. It is not uncommon for some patients to react painfully to the topical medication. Can you tell me how long after the application of the Beetle Juice you washed it off? If you continue with the same treatment, I recommend washing your foot 5-6 hours after the application of the Beetle Juice on your warts.
      Could you also let me know your location?

      Reply
  6. Sam Elline

    Informative article on plantar warts! It’s crucial for individuals with diabetes to be aware of potential foot issues, including brown spots on the bottom of the feet. Regular foot examinations and proper care can help prevent complications. #diabetes #foothealth

    Reply
  7. Lynn

    It’s weird I had a wart on my foot and have gone to a doctor for cryotherapy (with real liquid nitrogen) for about 5 times now and each time once the scab falls off the wart underneath is robust, healthy and almost bigger than ever. What can I say it’s growing on me… maybe the next cryotherapy will kill it once and for all

    Reply
    • Ali Nasr-Esfahani

      Hello Lynn,
      I appreciate your comment. Cryotherapy has long been considered one of the primary methods for treating warts, but it is not the most efficient treatment option. There are alternative choices that you can consider. I recommend visiting a chiropodist/podiatrist in your vicinity to explore these other treatment options. May I ask where you are currently located?

      Reply
  8. Maggie

    Is the needling method safe during pregnancy? I have been having my plantar warts treated with salicylic acid at the podiatrist with no luck but have been told they can’t attempt needling (or anything else) until after I give birth? Would it be due to the local anesthesia?

    Reply
    • Ali Nasr-Esfahani

      Hi Maggie,
      Thank you for your comment. Lidocaine is generally considered a safe treatment during pregnancy. Dentists use it also during pregnancy and there are no evidence showing there are adverse effects or risks of administrating Lidocaine during pregnancy. The needling treatment itself is also safe during pregnancy as it does not involve any other medication except Lidocaine. Here are two published reports about safety of Lidocaine during pregnancy.
      1- https://www.ncbi.nlm.nih.gov/books/NBK582791/
      2- In the conclusion section of this article is mentions: Fortunately, lidocaine, which is the most commonly used local anesthetic during dental treatments, is under category B and considered to have almost no negative effect on the mother and the fetus. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5564152/

      I hope it answered your question.

      Reply
  9. L.M.

    Hello, I have a very stubborn plantar wart. I’ve had it for about 7 years. Within the last 2-3 years it has grown much bigger. It started getting bigger after the beetle juice treatment. I am currently breast feeding. I have tried liquid nitrogen, cream, otc treatments, and the beetle juice. My dermatologist wants to keep going with the same treatments even though no progress has been made. She does not want to try any cutting or laser therapy because the wart will most likely come back. Please help…any suggestions?

    Reply
    • Ali Nasr-Esfahani

      Hi there, Thank you for your comment. I’m sorry to hear that you’re dealing with a stubborn wart. May I know where you live? If you have access to a clinic that offers SWIFT microwave treatment, I would highly recommend trying it. We’ve found that this treatment works well on resistant or mosaic warts. Please let me know if you have any further questions. If you prefer to discuss this privately, feel free to email me using our contact form or email address on our website.

      Reply
  10. Robin

    PS

    And I have 1 more question.

    Last year a new wart appeared on the palm of my hand, it came very quickly and it disappeared in 2 months completely. How can this happen? I mean all other warts are still there. Hope you have an idea. Thank you in advance. Best regards Robin

    Reply
  11. Robin

    Hi there. Iam from the Netherlands. I have warts under my feet, toes and fingers for more then 10 years. Tried everything nothing works. I have a question, when the HPV virus as smart as it is, can hide from the imunesystem, then how is it possible that most people’s warts disappear on their own? I mean, how does the immune system find the virus even though it’s hiding? Best regards. ROBIN

    Reply
    • Ali Nasr-Esfahani

      Hi Robin,
      Thank you for your comments. These are great questions and I try my best to address them.

      HPV, or the Human Papillomavirus, is indeed tricky because it can evade the immune system, at least temporarily. However, most people’s immune systems eventually recognize and combat the virus. Here’s how it works:
      1- Stealth Mode: Initially, HPV can hide from the immune system because it often infects cells in a way that doesn’t trigger a strong immune response. It tends to stay in the outer layer of the skin or mucosa and doesn’t cause significant cell damage that would alert the immune system.
      2- Immune System Adaptation: Over time, the immune system can adapt and begin to recognize the presence of HPV. This is partly due to the fact that as the virus replicates, it can cause abnormal changes in the infected cells, which can eventually be recognized as foreign by the immune system.
      3- Immune Response: Once the immune system recognizes these infected cells, it can mount a response to eliminate them. This can lead to the clearance of the virus and the disappearance of warts or other HPV-related lesions.
      4- Memory Response: After clearing the virus, the immune system typically retains a memory of HPV, which helps in protecting the body against future infections by the same strain of HPV.

      So, even though HPV is good at hiding, the immune system is often able to eventually detect and respond to the infection, leading to the resolution of warts in most cases.

      However, plantar warts that appear on the soles of the feet are usually stubborn and can indeed last for years or even a lifetime in some cases. Here’s why this happens, even in healthy individuals:
      1- Strong Immune Evasion by HPV: The strain (subtype) of HPV causing plantar warts is particularly good at evading the immune system. It can infect the skin without causing a strong immune response, making it harder for the body to recognize and fight off the virus.
      2- Thick Skin on Feet: The skin on the soles of the feet is thicker than in other areas, providing a protective environment for the virus. This thick skin barrier makes it more challenging for the immune system to reach and effectively combat the virus.
      3- Repeated Pressure and Friction: The feet are constantly under pressure and subject to friction, which can cause the warts to become ingrained and persist. This pressure can also lead to the warts growing inwards, making them even harder to clear.
      4- Variability in Immune Response: Individual differences in immune system effectiveness can play a significant role. Some people’s immune systems might be less effective at identifying and responding to the specific HPV strain causing the warts.
      5- Lack of Symptoms: Plantar warts might not cause significant discomfort or symptoms, leading individuals to delay or avoid treatment. Without intervention, the warts can persist for a prolonged period.

      I hope this answers your questions 🙂

      Reply
  12. Isabel

    Hello, my husband got 5 warts removed on his sole last October with laser. But there is one wart like cauliflower that is not healing from the start. It keeps coming back and we are tired of this.
    The doctor mention that the skin is delicate now and we don’t know what to do. We keep coming back to the same doctor and they put a chemical but no results. What should we do?
    Should we wait for his skin to recover and then do another treatment?

    Reply
    • Ali Nasr-Esfahani

      Hi Isabel, thank you for reaching out. May I know if your husband was seeing a family doctor or a chiropody/podiatry clinic? Also, could you please confirm if you are located in Ontario? In case you’re far from Orangeville, I can suggest a nearby clinic that can assist you with your husband’s wart. Otherwise, I would be happy to help and book an appointment for him. There are several other treatment options that we can help him with. You can also email me a photo of his wart for better assessment. I hope this information is helpful to you.

      Reply
  13. Mimi

    Hello..
    I did almost all and it came back..
    MMR injections, burning, freezing, acids, and surgery.. i am afraid of doing another surgery because the injections are so painful and it came back anyway .. now i have to wear insoles and try and shave it now and then myself because there is no podiatrist in my area.. if i were guaranteed the second surgery will work then i would do it again under local Anästhesie… meanwhile, i hobble around and try to manage it. Its on the ball of my foot and really not nice. Thanks for a very comprehensive article.
    Regards, M.

    Reply
    • orangevillefootclinic

      Hi Mimi,
      Thank you for your comment and sorry to hear that you’ve been dealing with the wart under your foot for a while. I’m afraid there isn’t any guarantee for medical procedures especially in case of plantar warts. Where are you located? As I haven’t seen your warts, I can’t comment on the treatment of choice but if you have access to a chiropody/podiatry clinic, ask if they provide alternative treatments such as Canthacur (beetle juice), needling, etc. I hope this helps.
      Best,
      Orangeville Foot Clinic

      Reply
  14. Claudia

    Hello and thank you for this awesome information. I have a question: I had a plantar wart and thankfully got rid of it with the 5-Flurouracil and Salicylic Acid. Now I am very scared of getting it again. Do I need to throw away all of my shoes because regular disinfectant doesn’t work? Thank you in advance!

    Reply
    • orangevillefootclinic

      Hi Claudia,
      Thank you for your comment and I’m glad that 5-Flurouracil + Sal acid worked on your warts. You don’t need to through all of your shoes away. You can take out their inserts and wash them thoroughly with hot water and soap. It is better to have gloves on. For the shoes that the insert does not come out, you can spray alcohol inside the shoe and on the insole. That should help. Let us know if you have any further questions.

      Reply

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