Dr. Vincent Giacalone
Podiatric Medicine & Surgery
466 Hook Rd., Suite 24D, Emerson, NJ 07630
What are plantar warts?
Plantar warts, also called verrucae (ver-ook-kay) are one of several soft tissue conditions of the foot that can be quite painful. They are caused by the human papilloma virus, which generally invades the skin through small or invisible pores, cuts and abrasions. They can appear anywhere on the skin, but, technically, only those on the sole of the foot are properly called plantar warts, as the word plantar means the bottom of the foot. Children, especially teenagers, tend to be more susceptible to warts than adults.
Most warts are relatively harmless, even though they may be painful and are often mistaken for corns or calluses. The wart, however, is a viral infection. It is also possible for a variety of more serious lesions to appear on the foot, including malignant lesions such as squamous or basal cell carcinomas and melanomas. Although rare, these conditions can sometimes be misidentified as a wart. It is wise to consult with Dr. Giacalone when any suspicious growth, lesion, mass or eruption is detected on the skin of the foot, ankle or leg in order to ensure a correct diagnosis.
Plantar warts tend to be firm and sometimes bumpy, with a rough surface with well-defined borders; warts are generally raised and fleshier when they appear on the top of the foot or on the toes. Plantar warts are frequently skin color, white, gray or brown (the color may vary), with a center that appears as one or more pinpoints of black.
Source of the Virus
The plantar wart is often contracted by walking barefoot on surfaces where the virus is. The virus which causes plantar warts is the human papilloma virus (HPV). There are many types of HPV, however the types which specifically cause plantar warts are the HPV number 1 and sometimes numbers 2,3,4,27,29 and 57. The virus thrives in warm, moist environments, making the virus a common occurrence in and around pools, jacuzzi’s, health clubs, gyms, locker rooms, karate facilities, dance classes, hotel rooms, etc. The virus can survive on floors and other surfaces for a long time. Normally, antibodies in the blood kills the virus, however some people are more susceptible to the human papilloma virus than others and HPV takes refuge in the skin.
If untreated, warts can grow to an inch or more in circumference and can spread into clusters of several warts; these are often called mosaic warts. Like any other infectious lesion, plantar warts are spread by touching, scratching, or even by contact with skin shed from another wart. The wart may also bleed, another route for spreading. Rarely, warts can spontaneously disappear after a short time, and, just as frequently, they can recur in the same location.
When plantar warts develop on the weight-bearing areas of the foot, such as the ball of the foot or the heel, they can be the source of sharp, burning pain. Pain occurs when weight is brought to bear directly on the wart, although pressure on the side of a wart can create equally intense pain. A plantar wart is similar in structure to an iceberg. The part on the surface is a small fraction of the entire lesion.
Tips for Prevention
- Avoid walking barefoot, especially around pools or locker rooms.
- Change shoes and socks daily.
- Keep feet clean and dry.
- Check children’s feet periodically.
- Avoid direct contact with warts—from other persons or from other parts of the body.
- Do not ignore growths on, or changes in, your skin.
Self-treatment is generally not advisable. Over-the-counter preparations contain acids or chemicals that destroy skin cells, and it takes an expert to destroy abnormal skin cells (warts) without also destroying surrounding healthy tissue. Self-treatment with such medications should be avoided especially by people with diabetes and those with cardiovascular or circulatory disorders. Never use them in the presence of an active infection.
Dr. Giacalone will prescribe and supervise your treatment plan. There are several different techniques for treating plantar warts:
Acid: One of the methods used is a mild acid applied topically to the wart. This effects the viral cells and allows healthy skin cells to replace them. Multiple (6-8) applications over the course of several weeks may be required. You may be asked to apply an acid patch on a daily basis to assist in the therapy and see Dr. Giacalone weekly to bi-weekly for treatment and debridement (removal of the dead skin) of the wart. This treatment may take 6-12 weeks. Also a cream called Aldara may be used alone or in combination with other treatments.
Cryotherapy: Freezing wart with a very cold applicator can kill the virus over the course of 6-8 weekly treatments. Cryotherapy is sometimes ineffective on plantar warts because the cold may not penetrate far enough to kill the virus completely. This treatment is usually used in combination with the acid treatment noted above, Aldara cream and debridement of the wart.
Surgical Excision: In this technique, Dr. Giacalone uses a scalpel to remove the warts under local anesthesia in the office. It is not the preferred method give the high success and lower pain associated with laser treatment noted below.
Laser Treatment: The major advantage to laser treatment of plantar warts is the fact that it is quick, relatively painless and simple to perform. The laser targets the blood vessels within the wart, causing it to shrink and heal over a period of several weeks. The laser is non-invasive and is not used to “cut-out” the wart. Most warts are resolved within 1 to 2 treatments, 2 to 3 weeks apart. Although this is not a surgical procedure Dr. Giacalone performs the laser treatment at the Surgery center in Oradell. There is no bleeding, cutting of skin or stitches/sutures and no bandage or dressing is required other than a simple band-aid. Patients can return to work or school immediately after the treatment. Laser treatment can be performed as a first treatment option or if other in-office treatment are unsuccessful.
Complications: Warts can return after treatment, indicating that the virus is still in the skin. The virus that causes plantar warts can spread to other parts of the body. Blood from a wart contains the virus and can cause a new wart to grow in an area it touches. Therefore, it is important to treat warts and eliminate them as quickly as possible.
Dr. Giacalone has been trained specifically and extensively in the diagnosis and medical and surgical treatment of foot disorders. Dr. Giacalone has been board certified by The American Board of Podiatric Orthopedics and The American Board of Podiatric Surgery since 1993 and 1995 respectively and is a Fellow of the American College of Foot and Ankle Surgeons. Dr. Giacalone performs surgery at Hackensack University Medical Center in Hackensack, Hackensack University Medical Center @ Pascack Valley in Westwood and Surgicare Surgical Center in Oradell.