Plantar Warts (Verrucas)

Medically known as verrucae, plantar warts present as a rough, circular growth in the skin on the bottom of your foot that can leave you feeling like you’re walking on a pebble when the wart develops on a weight-bearing area. The term ‘plantar wart’ simply translates to ‘wart on the bottom of the foot’.

Warts on the feet are caused by a virus called the human papillomavirus (HPV). Often mistaken for corns even by other health professionals, warts are notably distinguished by the small blood vessels that grow at the core of the wart to supply the viral cells with blood and nutrients and typically appear as little dark spots in the centre of the wart. Other characteristic features of plantar warts include:

• A small, round and grainy lesion that is growing on the sole of the foot (usually on the toes, the ball of the foot or the heel region).
• Pain when the wart is squeezed or pinched from its sides, with notably less pain when the wart is pressed directly upon 
• A marked border on the wart
• The lines of your skin tend to move around the wart, like they are making way for it, as opposed to remaining over the wart
• Callus overlying the wart may be present when it is on a weight bearing area. This can make it difficult to distinguish between a wart and a corn, and where debridement by your podiatrist is needed

In some cases, you may have a cluster of warts with multiple warts of varying sizes - often one notable large and original wart surrounded by several other small warts. This is called a mosaic wart.

The virus that is responsible for plantar warts is contagious and is transmitted by either direct or indirect contact. This means you could get it directly from someone who has the virus (e.g. skin to skin contact), or by sharing floor surfaces, shoes or socks with someone that is infected. However, not everyone that comes in contact with the virus will develop warts, as each person's immune system responds differently to the viral strains. 

The virus thrives in warm, moist environments, so is commonly picked up from communal areas such as public showers and pools, entering your body through a cut or a break in the skin. It also tends to be rapidly spread in childhood, especially in schools where there is a high level of exposure to public spaces and immunity is still developing.

Plantar warts can be very tricky to treat at home. They do resolve on their own, but this process can be unpredictable, take months or years, and cause much pain in the interim if present on a weight-bearing area of the foot. This is why most people choose to have them professionally treated. 

There are a number of suggested home remedies for plantar warts including duct tape, tea tree or even apple cider vinegar. Unfortunately, none of these options have any scientific evidence that show any efficacy when it comes to plantar warts, and as such, we do not recommend them.

With the acids that are available for purchase from the pharmacy that are designed to be applied to the wart, we strongly recommend against using these. Often coming in the form of a solution or wart pad, these typically contain keratolytic ingredients to ‘eat away’ and dissolve the wart tissue. Unfortunately, the solution cannot tell between the wart tissue and the healthy surrounding skin, and so we see many people who have sustained a painful injury and damaged the healthy skin around the wart, making it very painful for them to walk.

Prevention over cure

When it comes to plantar warts, prevention is always better than cure. We highly recommend wearing shoes when in communal areas like changing rooms, locker rooms and showers, where others may be walking around with bare feet and with warts present on their feet.  

You’re in the best hands with our experienced podiatrists when it comes to caring for the warts on the bottom of your feet. We have a range of treatments available to best suit every person’s unique circumstances, including the location of their warts, pain levels, treatment history, preferences and medical conditions. These include:

• Using a potent solution or ointment (e.g. salicylic acid) - we have specialist high-concentration ointments available to be applied over the wart after a thorough preparation process. This process involves debriding the surface of the wart to remove any overlying callus and expose the wart tissue, purposefully achieving slight bleeding by exposing the tiny speck-like blood vessels in the wart, safely applying the solution while ensuring it does not exceed the wart margins, and occluding the wart with two types of tape. This is kept on for four days, where it must be kept dry. The wart is then reassessed and re-treated in two weeks. We have a 75% success rate with this method in our clinic.
• Dry needling - our dry needling procedure also has a great success rate, and is done under local anaesthetic to the area beneath the wart, making it a painless procedure. A thin, sterile needle is used to repeatedly puncture the wart, driving wart cells further below into the skin, as warts are otherwise located in the upper skin layers which can ‘mask’ them from the immune system. By exposing the presence of the viral cells, an immune response is triggered to help clear the virus. This procedure is fast, and does not cause much bleeding as the needle is very thin.
• Freezing the wart - known as cryotherapy, we can also freeze the wart using liquid nitrogen. This process also goes through a preparation stage where we debride the surface layer of the wart followed by applying the liquid nitrogen three times consecutively, for 20-30 seconds per application depending on the size of the wart.