Plantar Wart Symptoms, Causes & Treatment Options

Plantar warts are warts growing on the bottom of the feet that may grow inward rather than outward. These may go away on their own or may recur despite treatment, and a large variety of treatment options is available.

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Contents

  1. Overview
  2. Symptoms
  3. Potential Causes
  4. Treatment, Prevention and Relief
  5. When to Seek Further Consultation
  6. References

What Is A Plantar Wart?

Summary

Warts are benign, textured growths of the skin that are triggered by an infection of skin cells with a strain of the contagious human papillomavirus. Plantar warts are warts that occur on the soles of the feet. Unlike common warts that grow outward forming bumps on the skin, plantar warts grow inward into the flesh of the foot. They appear as thickened, rough, or discolored patches of skin on the sole of the foot, and they may be very uncomfortable, even to the point of preventing walking. A huge variety of options exist for treating plantar warts, from simple observation or occlusion with duct tape to invasive surgical and laser procedures that directly destroy the wart. Topical and injected medications exist as well in between these extremes. Many plantar warts will resolve on their own, though some will be recurrent despite treatment.

Recommended care

Plantar Wart Symptoms

Main symptoms

Deep palmoplantar warts are the same disease as common warts (that you may be familiar with), only deep palmoplantar warts occur on the soles of the feet or the palms of the hands. Below are some details about the appearance and symptoms of deep palmoplantar warts:

  • Warts: Warts are bumpy growths that can occur on any surface of the body. They may be flesh-colored, pale, or grey. Often, they will have black dots visible on or beneath their surface.
  • Location: By definition, deep palmoplantar warts occur on the soles of the feet or palms of the hands. The soles of the feet are a more common location for these warts to occur.
  • Flat: Because they usually develop on the sole of the foot, a surface under almost constant pressure, plantar warts will often lie flush with the surface of the skin on the bottom of the foot, with the wart growing inward.
  • Thickening: Since plantar warts grow inward rather than outward, they may just look like thickened, discolored, or textured skin.
  • Pain: Another consequence of plantar warts’ growing inward rather than outward is that they can be quite uncomfortable. In some cases, they may feel like a pebble is caught in your shoe. In worse cases, pain may impair the ability to walk or wear shoes [1].
  • Mosaic warts: Many plantar warts may coalesce into a large area of thickened, wart filled skin in a pattern called mosaic warts.

Plantar Wart Causes

A wart is a benign (non-cancerous) growth that occurs when a specific type of virus infects some of your skin cells, causing them to grow irregularly. The viruses that cause warts are called the Human Papilloma Viruses, and there are more than 200 specific types of human papillomavirus (sometimes called “HPV”). The HPV strains most likely to cause plantar warts are types 1, 2, and 4.

The viruses causing warts, like plantar warts, are transmitted by direct contact. This can mean direct skin to skin contact with someone’s warts, as well as contact with objects, furniture, and surfaces that have also had contact with warts. Warts can also be spread by auto-inoculation, meaning spread from one part of the body to another on the same person.

Warts are a common benign growth that affects approximately 10% of all people worldwide. Certain people are more likely to get warts than others, as detailed below:

  • Children: Especially school-aged children and adolescents are more likely to have warts including plantar warts. An estimated 20% of school-aged children have warts worldwide (versus 10% of the total population.)
  • White or Caucasian people are more likely to get warts and plantar warts than people of other races.
  • Butchers: People who handle meat for a living may be more likely to have certain types of warts.
  • Immune compromise: People with compromised immune systems, from medical conditions like HIV or AIDS, or from certain medications, are more likely to have warts and may have more severe warts.

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Treatment Options, Relief, and Prevention for Plantar Warts

Easiest Treatments

There are many treatments available for plantar warts; however, warts will often recur even after treatment. For this reason, it is recommended that you start with easy to use, inexpensive treatments, and progress gradually to more involved or more expensive treatments. Some of the very easiest treatments are listed below:

  • Do nothing (observation): Doing nothing, and merely observing the wart to make sure it does not progress, may be the only necessary treatment. Approximately 2/3 of warts will disappear on their own over 1-2 years. One downside of this plan is that it takes time and that the wart may remain contagious throughout.
  • Occlusion: There is some evidence to suggest merely occluding the wart with a sturdy tape like duct tape may be equally as effective as other more invasive treatments.

Topical Treatments

Many wart treatments are topical medications that can be applied directly to the wart, sometimes at home:

  • Salicylic acid: This topical solution is a good first treatment for plantar warts. It is available over the counter and may successfully treat smaller warts.
  • Topical retinoids: Examples include tretinoin cream or adapalene gel.
  • Imiquimod cream: This topical medication stimulates the body’s immune system, causing it to react against the offending wart.
  • Cantharidin: This substance is derived from the toxin of the blister beetle. It causes the skin to blister and can be applied to warts to destroy them.
  • Topical chemotherapies: Podophyllin cream, 5-fluorouracil, and bleomycin creams all disable and kill rapidly growing cells like the cells inside of a wart.

Destructive Treatments

These treatments directly destroy wart tissue, though they are more invasive. Even after being destroyed, warts may still recur.

  • Cryotherapy: In this treatment, liquid nitrogen is sprayed directly onto the plantar wart to freeze and destroy the infected cells. This treatment is usually administered every 2 weeks over the course of several months.
  • Curettage and electrodesiccation: This treatment is more invasive than cryotherapy. It involves scraping the wart with a sharp loop-shaped tool called a curette, then destroying the base of the wart using an electrical cautery tool under local anesthetic. This treatment may leave a scar.
  • Laser therapy: A CO2 laser can be used to destroy warts.

Other Advanced Treatments

If the above treatments fail, many others are still available. Some are listed below:

  • Intralesional injections: In these treatments, toxins (like candida antigen, a tuberculin PPD, or the chemotherapy bleomycin) are injected directly into the wart, destroying it while ramping up the body’s own immune response to the wart.
  • Intralesional cidofovir: Cidofovir is a targeted antiviral medication that may be effective when injected directly into a wart.
  • Other experimental therapies: Oral cimetidine ( a drug usually used for heartburn), oral retinoids (usually used for severe acne) oral zinc oxide (a mineral), topical raw garlic, and topical tea tree oil have all been used experimentally against warts [2,3].

Prevention

The strategies below may help to prevent plantar and other warts.

  • Hygiene: Keep feet cool, clean, and dry, and avoid contact with possibly contagious surfaces – this means wearing proper footwear in showers and at the pool.
  • Occlude and treat other warts: Since warts can spread from one area to another on a single individual, it is good prevention to occlude active warts with duct tape or bandages and treat them promptly before they can spread.
  • Vaccines: Though the HPV vaccine is directed against strains of the virus that cause cervical cancer and genital warts, there is anecdotal evidence that this vaccine may help to prevent common and plantar warts as well [4].

When to Seek Further Consultation for Plantar Warts

It is not necessary to seek consultation with a dermatologist right away for small numbers of warts that are not uncomfortable or unsightly, however, it is never wrong to seek treatment for a wart that you don’t like having.

In addition, if you acquire numerous warts, or if warts are persistent, fast-growing, or progressing quickly, you may want to consult with a physician, as this can be the first sign of a new immune system compromise that should be worked up.

Finally, on rare occasions, warts can progress from benign growths to malignant skin cancers. Certain skin cancers may also be mistaken for warts at times. For these reasons, see a dermatologist if you find a suspicious or different-appearing wart.