Patient Education

© 1999-2003 by Seth A. Rubenstein, D.P.M.

Plantar warts are produced from a viral infection in the skin. While plantar warts occur on the bottom or "plantar" part of the foot, wart infections can occur on any skin surface.

Plantar warts are often confused with callus, a thickening of the skin which occurs due to abnormal pressure points. On the bottom of the foot, finger print lines can be seen on the surface of a callus. The finger print lines do not pass through wart tissue, which resembles a cauliflower texture. Small black dots may appear in the body of the wart. These are ruptured capillaries which grow up into and help feed the wart. Plantar warts can be focal and deep or spread out and remain superficial (mosaic wart).

Figure 1
Superficial "mosaic" wart. Note capillary hemmorage (black dots) in wart tissue.

 

 

 

 

 

 

Figure 2
Deep plantar wart on heel.

 

 

 

 

 

 

 

Figure 3
Excision of deep wart. Note white glistening appearance of wart tissue.

 

 

 

 

 

 

Popular treatments include topical acids, liquid nitrogen applied topically, or surgical excision with electrocautery or laser.

The virus exists throughout our environment. It is not clear why some people are more susceptible to infection than others. For infection to occur, the virus must first get into the skin. This can occur through a scrape, cut or if the skin is made more permeable, as may occur when it is very wet. Because the virus is an infectious process, it can spread.

Treatment is best undertaken as soon as the infection is recognized. There are dozens of treatment options available which serves to illustrate the unfortunate fact that no one remedy outshines any other. Popular treatments include topical acids, liquid nitrogen applied topically or surgical excision with electrocautery or laser. Most store bought acids do not work on the bottom of the foot due to the thickness of the skin.

Surgical excision works well; however, recurrences can occur. This is due to the microscopic nature of the virus and the surgeon's inability to recognize a new, still microscopic colony on the edge of, or adjacent to, the surgical site. Following excision, it is prudent to keep the surgical site dry while bathing, to help prevent reinfection of the healing wound. The time for healing after excision can vary from one to several weeks, dependent upon the size and location of the surgical site.

Figure 5
Laser treatment of wart excision site. Note plastic smoke evacuation tube in background.







Figure 6
Four days after laser treatment, wart site beginning to heal.







Figure 7
Two weeks after wart excision and laser cautery.