What is it?
Warts are the manifestation and growth of a contagious virus (HPV, the Human Papillomavirus) that invades the skin through small cuts or abrasions on its surface - even through openings that are too small to be seen with the naked eye. Once inside the skin, the virus can grow and spread, stimulating the rapid generation of cells on the surface of your skin. There are over 60 different strains of HPV. Technically, warts may appear anywhere on the skin, but only those that appear on the soles of the feet are known as plantar warts.

What to look for:
 If you see a bump on the sole of your foot that changes over time, suspect plantar warts. Both plantar warts and common warts (those occurring on other areas of the body) may be flesh-colored, white, tan or pink. Plantar warts are often grey or brown. Some warts may develop an uneven surface and a cauliflower-like texture over time, or they may acquire black spots or streaky lines. The black dots or lines are characteristic of plantar warts, and are caused by the bleeding of small blood vessels into the tissue. Warts also can bleed profusely when accidentally scratched or cut.

Warts start as small bumps, but can grow to an inch or more if left untreated. They can spread to other parts of the body, or form clusters.

A wart may or may not be painful, depending on its location. Warts on the ball of the foot or the heel, for example, where weight and pressure are brought to bear, may cause the patient great pain.

Other notes:
Plantar warts (and warts in general) are not caused by toads. (That’s an old wives’ tale - toads simply have bumpy skin; they don’t carry HPV). Only people can pass warts to other people - either from direct skin-to-skin contact or from inadvertently leaving the virus somewhere where others can pick it up. For example, the virus can be spread when one person with plantar warts walks barefoot on ground where others do the same. The virus can also be spread if a patient with plantar warts loans shoes or socks, which have not been washed, to an uninfected person.

Warts can easily be spread to areas around the body other than the feet, such as when the patient touches the plantar wart, and then touches another area of his or her body, such as the hands, face, genitals, scalp, arms, legs, ears - you name it. If the wart bleeds (such as when it is nicked or cut accidentally), this creates an ideal avenue for infection of another part of the body, or another person.

Warts are also stubborn and frustrating. They may disappear for a while, and then recur in the same place. They may go away with treatment and then come back - or they may never recur. Children seem to be more prone to warts than adults, leading some medical experts to theorize that as they age, some people can develop immunities to the virus that causes warts.

What it means to you:
Plantar warts (and all warts) are often unsightly and sometimes painful, but not life-threatening. That said, however, it is important to note that there are various lesions of the skin on the foot, including corns, callouses, moles - and even a few rare cancerous growths - that have similar or identical characteristics. It’s best to have a podiatric physician examine any growth on your foot to ascertain that it is indeed a wart. Many common warts can be addressed with over-the-counter medications; however, it depends on the specific type of wart, and how far it has progressed.

What causes it?
You acquire the wart virus through direct contact with an infected person, or by coming into contact with an infected surface, such as a shower room floor. The virus lives in a warm, moist environment. It’s generally difficult to tell when or where you came into contact with the organism, however, since the incubation period for the HPV can be up to three months, although a wart itself can lie dormant for years.

What cures it?
IMPORTANT: If you have diabetes, you should see your podiatric physician at the first sign of any problems with the skin of your feet or toes, no matter how minor you may think they are. The following precautions and steps may be recommended by your podiatric physician, but should not be undertaken without his/her supervision and consent.

Plantar warts are stubborn, and most of the time, will require a podiatric physician’s intervention before they’ll go away. Sorry to disappoint those who believe in home remedies, but this is not the time to try holistic medicine, your Grandmom’s favorite wart remover, a pumice stone or anything else your doctor didn’t recommend.

There are various preparations on the market which can be used to treat warts. However, it is essential to receive confirmation from your healthcare professional that the lesion you want to treat is, in fact, a wart, and not something else. By self-diagnosing and treating without medical supervision, you may actually do yourself more harm than good. Plus, since some of the remedies on the market contain acid, they can irritate, damage and scar normal skin, or worsen a condition that is not a wart.

A podiatric physician, upon diagnosing a plantar wart, may recommend a prescription medication (or in some rare cases, an over-the-counter remedy) designed for warts. If, however, the condition looks fairly entrenched - and plantar warts are known to be very stubborn - several other methods may be used to treat it.

• Because a wart is a virus, the goal of the professional is to remove the affected area that contains the warty skin cells, while keeping damage to the surrounding tissue to a minimum. In this case, the doctor may choose one of several methods:   Freezing the wart (also known as cryotherapy): In this procedure, the doctor destroys the wart by treating it with liquid nitrogen. The patient will notice that the affected area develops a blister, which falls away within a week to reveal unaffected tissue underneath. This is generally many doctors’ first choice of treatments, since it is conservative and causes very little tissue damage or pain. Unfortunately, repeated treatments may be needed, should the entire wart not be removed the first time.
   
• Injection of medication: A doctor may choose to inject the wart with a drug that will attack the virus. Bleomycin and interferon-alpha have been used with success in these applications.
   
• Surgical procedures: Your podiatric physician may choose to use a technique that involves cutting away the wart via a process called electrodesiccation and curettage, which uses an electric needle. Some patients find this procedure painful, and scarring can result; however, it is an effective form of treatment that often results in long-term wart removal. Note: Do not try to cut anything you suspect to be a wart off of your own skin. This is extremely dangerous and can lead to infection and scarring, among other problems.
   
• Laser surgery: There are two procedures for laser wart removal; your podiatric physician can decide which is best. One type of laser cuts away the growth; another cauterizes the blood vessels that feed it so that the wart dies and falls away on its own. Laser surgery may also be painful and may require a longer healing time.
   
• Chemical removal. Your podiatrist may choose to use one ore more chemicals to remove the wart.

Your podiatric physician will be best able to recommend a treatment method based on your specific condition; listen to his/her recommendations, and do not be afraid to ask for a second opinion if you are concerned.

How can plantar warts be prevented?
The best way to prevent a plantar wart is to keep your feet clean, and to keep them away from surfaces on which the HPV might be lurking. Avoid walking barefoot, and wear sandals or some kind of foot covering at pools and in locker rooms and other warm, moist communal areas where people go barefoot. Change your shoes and socks daily, and allow your shoes to dry thoroughly between each wearing. Do not wear the shoes or socks of others, not even those of your closest friends. Wash socks after each wearing. (In this case, it’s the same kind of preventive medicine that is advised for athlete’s foot - another infection that can be picked up in public areas)

Keep your feet clean and dry, and since children are prone to warts, encourage them to do the same, and to follow the above rules as well. Check kids’ feet periodically and report any suspicious bumps, growths or lesions to your pediatrician. Remember that kids are easily frightened by medical procedures, and the earlier a wart is diagnosed, the easier it will be to get rid of it.

If a wart is diagnosed, do not pick, pull or try to snip at it, and don’t try to rub it with a pumice stone or with any kind of lotion. Don’t ignore it, either! Put a band-aid over the area to discourage contact with it and see a doctor. If it’s a wart, you’ll have caught it early. If it’s not a wart - well, you’ll still have caught it early, no matter what it turns out to be. Wash your hands carefully after caring for the affected area, and do not touch yourself anywhere before you wash those hands!

Remember that HPV is a highly contagious virus, and that it will spread if not treated. Don’t give it a fighting chance. If you or your children notice a wart - on your feet or on any part of your body - reduce the risk of it spreading while it’s being treated. Avoid brushing, clipping, shaving or combing the area over and around the wart in order to avoid nicking or cutting the wart and causing it to bleed. Don’t use the same nail clipper or file on hands or feet that have warts as you do on hands or feet that don’t.

Who can help me? The American College of Foot & Ankle Orthopedics & Medicine (ACFAOM) stands ready to help you find a podiatric physician in your area. Simply click on our foot-help-finder link to find the professional who can help you find the most effective treatment.