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Plantar Warts
The common wart is known as verruca vulgaris.
They are caused by a viral infection of the skin. This occurs as a
result of direct contact with the virus. They do not spread through the
blood stream. They occur more commonly in children than adults. When
they occur on the bottom of the foot, they are called plantar warts.
This name is derived from the location of the foot on which they are
found; the bottom of the foot is called the plantar aspect of the foot.
A common misconception is that plantar warts have seeds or roots that
grow through the skin and can attach to the bone. The wart may appear
to have a root or seeds, but these are in fact small clusters of the
wart just beneath the top layer of the skin. The wart cannot live in
any tissue except the skin. Moist, sweaty feet
can predispose to infection by the wart virus. They can be picked up in
showers and around swimming pools. They are not highly contagious, but
being exposed in just the right situation will lead to the development
of the wart. Avoiding contact in the general environment is nearly
impossible. If a member of the family has the infection, care should be
taken to keep shower and tile floor clean. Children who have plantar
warts should not share their shoes with other people. Young girls often
share shoes with their friends and this should be discouraged. Diagnosis The
warts have the appearance of thick, scaly skin. They can occur as
small, single warts or can cluster into large areas. These clustered
warts are called mosaic warts. They often resemble plantar calluses.
A simple way to tell the difference between a wart and a callus is to
squeeze the lesion between your fingers in a pinching fashion. If this
is painful, it is likely that the lesion is a wart. A callus is
generally not painful with this maneuver but is tender with direct
pressure by pressing directly on the lesion. Other lesions on the
bottom of the foot that are often confused with plantars warts are
porokeratoses and inclusion cysts. Treatment There
are a variety of ways to treat warts. The over-the-counter medications
have a difficult time penetrating the thick skin on the bottom of the
foot, so they do not work well in this area. Professional treatment
consists of burning the wart with topical acids, freezing with liquid
nitrogen, laser surgery or cutting them out. All methods have the
possibility of the wart coming back. Surgical excision of the wart has
the highest success rate with a relatively low rate of recurrence.
There is some mild discomfort with this procedure and it takes several
weeks for the area to completely heal. Normal activity can generally be
resumed in a few days depending on the size and number of warts that
have been removed. The risks associated with surgical removal of warts
are the possibility of infection, or the formation of a scar, which can
be painful when weight is applied while walking. Laser
removal of the wart works by burning the wart with a laser beam. The
area must be numbed with an anesthetic prior to the procedure. There is
little advantage to removing warts with a laser unless the warts are
very large (mosaic warts) or there are a large number to be removed.
The risks associated with the use of the laser are the same as for
cutting the warts out. These risks include infection and the
development of a scar after healing. A new type of laser has been
developed to treat several different types of skin lesions called the
Pulsed Dye Laser. This new laser has promise in the effective treatment
of warts. Freezing the wart with liquid nitrogen
is another form of treatment. This form of treatment when the warts are
on the bottom of the foot can be very painful and take several days or
weeks to heal. Topical acids can also be a useful
means of treating warts. The advantage to this form of treatment is the
fact that they are nearly painless and there is no restriction of
activity. The down side to this form of treatment is that it frequently
requires several treatments and the failure rate is higher than
surgical excision of the wart.
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