Plantar warts

Plantar warts

Definition:

Plantar warts are noncancerous skin growths on the soles of your feet caused by the human papillomavirus (HPV), which enters your body through tiny cuts, breaks or other vulnerable sites on the skin of your feet.
Plantar warts often develop beneath pressure points in your feet, such as the heels or balls of your feet. This pressure also may cause a plantar wart to grow inward beneath a hard, thick layer of skin (callus).

Most plantar warts aren't a serious health concern and may not require treatment. However, plantar warts can be bothersome or painful. If self-care treatments for plantar warts don't work, you may need to see your doctor to have them removed.

Symptoms:

Signs and symptoms of plantar warts include:

• Small, fleshy, grainy lesions, or growths, on the soles of your feet
• Hard, thickened skin (callus) over a well-defined "spot" on the skin, where a wart has grown inwards
• Black pinpoints, which are commonly called "wart seeds" but are actually small, clotted blood vessels
• Lesions that interrupt the normal lines and ridges in the skin of your feet
• Pain or tenderness when walking or standing

When to see a doctor
See your doctor if:

• The lesions are painful or change in appearance or color
• The warts persist, multiply or recur, despite home treatment
• The warts interfere with your activities
• You have diabetes or nerve damage (neuropathy) in your feet — in which case, you should not use at-home treatments
• You have a weakened immune system because of HIV/AIDS, immune-suppressing drugs or other immune system disorders
• You have any doubt that the lesion is a wart

In these cases, your doctor may prescribe a closely monitored treatment plan or consider a different diagnosis.

Causes:


Plantar warts are caused by an infection with the human papillomavirus (HPV) in the outer layer of skin on the sole of your feet.
There are more than 100 types of HPV, but only a few types are known to cause warts on your feet. Other types of HPV are more likely to cause warts on other areas of your skin or on mucous membranes.
Transmission of the virus
Each person's immune system responds differently to HPV, so not everyone who comes in contact with the virus develops warts. Even people in the same family react to the virus differently.
The HPV strains that cause plantar warts aren't highly contagious. Therefore, it isn't easily transmitted by direct contact from one person to another. However, the virus does thrive in warm, moist environments — such as shower floors, locker rooms and public swimming areas. Consequently, you may contract the virus by walking barefoot around pools or gyms.
The virus also needs to have a point of entry into the skin:

• Cracks in dry skin
• Cuts or scrapes
• Wet, softened, fragile skin from prolonged water exposure (macerated skin)

Multiple warts
If the virus spreads from the original site of infection, multiple warts may appear. These may include:

• Several individual warts at different sites on the foot
• "Kissing warts," a pair of warts that appear where two parts of the foot touch, such as a point of contact between two toes or between a toe and the ball of foot
• Mosaics, clusters of warts that essentially form a large, single lesion

Complications:

 When plantar warts cause pain, you may alter your normal posture or gait — perhaps without realizing the change. A difference in how you stand, walk or run can eventually cause muscle or joint discomfort.

Treatments and Drugs :

Plantar warts often don't require treatment. Most warts resolve on their own without treatment within a couple of years. However, if they are causing pain or spreading, they should be treated. It's much easier to treat a few small warts than several large warts.
Plantar warts can stubbornly resist treatment. Therefore, most treatments require patience, persistence and multiple interventions.
People with diabetes, nerve damage in their feet or weakened immunity need treatment under a doctor's supervision. Your doctor will closely monitor the treatment effect and the quality of wound healing.

Treatments provided by your doctor
If home remedies aren't working, your doctor may recommend other treatments. Doctors generally start with the method that is least likely to result in pain, side effects and scarring. Scarring on the sole of the foot can be painful and is usually irreversible. Treatments often need to be repeated, and warts may return at a later time.
Treatment options include the following:

• Freezing (cryotherapy). Your doctor can apply liquid nitrogen with a spray canister or cotton-tipped applicator to freeze and destroy your wart. The chemical causes a blister to form around your wart, and the dead tissue sloughs off within a week or so. The application itself can be painful, and cryotherapy can result in painful or tender blisters that resolve on their own.
• Cantharidin. Your doctor may use cantharidin — a substance extracted from the blister beetle — on your plantar warts. Typically, the extract is paired with salicylic acid, applied to the plantar wart and covered with a bandage. The initial application is painless, but the subsequent blister that forms can be quite painful. Your doctor clips away the dead part of the wart in about a week.
• Immunotherapy. This therapy attempts to harness your body's immune system to remove tough-to-treat warts. This can be accomplished in a couple of ways. Your doctor may inject your warts with interferon, a medication that boosts your immune system's instinct to reject warts. Or your doctor may inject your warts with a foreign substance (antigen) that stimulates your immune system. Doctors often use mump antigens, because many people are immunized against mumps. As a result, the antigen sets off an immune reaction that may fight off warts. Interferon treatment may result in flu-like symptoms for a few hours after treatment. Both treatments may cause pain.
• Imiquimod (Aldara). This prescription cream applied directly to a wart is an immunotherapy medication that encourages your body to release immune system proteins (cytokines) to attack HPV. This treatment can result in severe inflammation near the site and damage to the tissues beyond the wart. If this occurs, the treatment is dropped. The drug may also result in flu-like symptoms that may lessen with a lower dosage.
• Minor surgery. This involves cutting away the wart or destroying the wart by using an electric needle in a process called electrodesiccation and curettage. Your doctor will anesthetize your skin before this procedure. This treatment is avoided if possible with plantar warts because of the risk of scarring.
• Laser treatment. A type of laser treatment called pulse dye laser treatment burns closed (cauterizes) tiny blood vessels. The infected tissue eventually dies, and the wart falls off. This treatment can cause pain and scarring.