What Are Plantar Warts?

  • Dr Prerna YadavBachelor of Dental Surgery- BDS, Kothiwal Dental College & Research Centre Moradabad, India

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Overview

Plantar warts are frequent skin lesions. A strain of the human papillomavirus (HPV) causes plantar warts, which usually occur on the sole of the foot. Many individuals may have HPV infections without displaying any symptoms and are more sensitive to developing plantar warts. Plantar warts and HPV shedding can spread infection to nearby areas or others. Reducing risk factors is challenging due to the prevailing HPV infection. Approximately 14% of the population gets affected by plantar warts every year.1

Children and adolescents are the primary victims of this condition. Communities with weak immune systems are at higher risk of plantar warts. Complications may include pain, discomfort, and even cancer. Plantar warts are also known as verrucae plantaris. Plantar warts are commonly seen in all genders and races but some ethnicities may show higher incidence than others.

Signs and symptoms

Plantar warts have evident characteristics, but their severity differs among people. Here are some common signs and symptoms:

Black seeds or dots

Little black dots or seeds (wart seeds) inside the lesion are a classic trait of plantar warts. Wart seeds are just small clotted blood vessels. They become noticeable when the lesion gets bigger and puts pressure on the foot. Some people may mistake these for seed warts.

Pain, uneasiness, or sensitivity

Plantar warts can make you feel uncomfortable and sometimes hurt or be sensitive when you walk or stand. Plantar warts develop inside the skin and cause pain. These sores get worse and widen. They harm the skin tissues around them, making the skin sensitive.

Skin thickening

The plantar wart starts as thickened skin in the area. It is the body's way of guarding itself and reducing pain and discomfort. Frequent walking and standing can cause stress and resistance. This can result in hardened and calloused skin in the wart area. The skin padding protects underlying tissues from direct pressure and sensitivity.

Individual or assembled representation

Plantar warts come in different sizes. They can appear as individual elongated areas of spread. Frequent foot pressure can incite mosaic warts. Mosaic warts are bunches of plantar warts close together on the foot. They combine to form a more extensive, uneven fragment. People with weak immune systems and those who frequently walk barefoot in public places are more likely to have it.

Recognisable clear-bordered lesions

Plantar warts are minute coarse sores on the bottom of the foot. Sometimes, they appear with clear borders. The borders differ from the skin around them. PW lesions may have different colours (e.g. skin colour, grey, or brown). Blood vessels and the thickness of the skin can change the colour of the lesion. However, more symptoms are needed to determine the seriousness of the lesions.

Cause

HPV as the determinant factor

The human papillomavirus (HPV) gives rise to plantar warts. HPV is strikingly transmittable and primarily affects the outer layer of the skin. Certain strains of HPV, such as types 1, 2, 4, 60, and 63, cause plantar warts.

Transmission of the virus

HPV flourishes in a warm, moist atmosphere. The virus passes on the external skin layer on the soles of the feet. The virus infects the foot via minor wounds, injuries, or bruises. People often get these infections when they walk without shoes in public places. These places include showers, swimming pools, and shared public spaces.

Transmittable nature

Direct contact with infected surfaces transmits the virus. Plantar warts can spread by coming into contact with the skin of an infected individual. 

The virus invades the outermost layer of skin. Skin cells incorporate it into their genetic material. Hindrance occurs in normal cell division and replication. This leads to quick multiplication and reserves diseased cells. A planter wart is formed.

Wart development

The virus causes warts to grow inward, making them difficult to detect by the immune system. These typical complications limit the body's ability to discard infected tissue effectively. This enables the plantar warts to prevail for longer durations without treatment.

Diagnosis and investigations

The diagnosis of Plantar Warts can be made based on the following aspects:

Clinical features

Dermatologists/Healthcare providers perform a thorough examination by observing elevated bumps and discolouration of the skin. This method accurately diagnoses plantar warts.

Thickened skin identifies warts commonly occurring on areas of the body that experience pressure. You can see dots or lines in the lesion. These dots or lines show broken capillaries. Broken capillaries can appear red or brown.

Manual analysis by scalpel

A skilled healthcare professional or dermatologist uses a scalpel to cut the superficial layer of the wart. Examiners do this to analyse any small, clotted blood vessels or dots. The diagnosis of mosaic warts can be more complicated. Many neighbouring verrucae (small lumps on the skin) combine to create mosaic warts.8,9

Biopsy

A tiny part of the wart is removed with a scalpel and sent to a lab to check for the presence of HPV.

Dermatoscope

Skilled dermatologists use a hand-held dermatoscope to detect red or purple blood vessels. White keratin lobules (circles) surround warts. Blood vessels may become noticeable after shaving off the outer layers of hyperkeratotic tissue (thickened tissue due to too much keratin).

Other conditions that share the same appearance

  • Corns (small round thickened bumps on the skin, typically on the feet) can be identified by the presence of a translucent core. It appears as concentric white rings when inspected using a dermatoscope
  • Calluses emerge as areas of consistent opacity without any visible structure when viewed under dermatoscopy
  • Even though melanoma is rare, doctors should consider it a possible diagnosis for people suspected of having a plantar wart
  • Others: Seborrheic keratosis, Keratoacanthom, Molluscum contagiosum, Lichen planus, and Squamous cell cancer

Treatment and management

Natural healing with time

Around 80% of plantar warts will disappear within two years. Patients can choose a cheap and less painful initial treatment option.

Topical treatments and some other therapies

It is best to use wart paints and gels containing salicylic acid for initial treatment. Topical medications like retinoic acid, podophyllin, topical 5-fluorouracil, interferon, and imiquimod work well.

Silver nitrate

In 30% of cases, the direct application of Silver nitrate proves to be beneficial.

You may need to use it up to six times, but be careful because it can cause stains and chemical burns.

Fluorouracil (5-FU) cream

Fluorouracil 5% cream is a chemotherapy drug. It can eliminate the problem often(around 12 weeks; 95% success rate).

Other

Cidofovir, intralesional injections with immunotherapy, bleomycin, and interferon alfa have effectively treated plantar warts. Using the medication twice with occlusive dressing can cause pain, blistering, and local irritation.

Surgical Options

  • Cryotherapy
  • Laser 
  • Electrodesiccation
  • Surgical excision in some cases when required

Nonpharmacological and unsubstantiated therapies

Non-drug treatments, like adhesiotherapy, hyperthermia, hypnosis, topical zinc cream(15-40%), propolis(a resinous, waxy substance made by bees), and plant extracts are also utilised. But we need controlled trials to prove they work.

Recurrent or resistant cases

For many recurrent warts, more pricey and invasive treatments may taken into account. This will depend on the patient's symptoms, preferences, and cost.

HPV vaccination

In some instances, people with stubborn plantar warts have found relief when given the quadrivalent HPV vaccine( not enough evidence; not checked in clinical trials yet).

Risk factors

  • Warts are most common in people aged 12 to 16. This is due to increased exposure in public spaces like school pools
  • The ratio of plantar warts affecting males and females is approximately equal. However, certain factors can increase the risk regardless of gender
  • People with weakened immune systems, like immunocompromised individuals and meat handlers, are at increased risk
  • Walking barefoot in communal areas with a high risk of virus transmission, such as locker rooms and showers, can be especially dangerous
  • Cuts, injuries, or skin infections on feet can let the virus in
  • The risk of getting warts increases when you have direct contact with someone who has them
  • Participating in athletics, certain occupations, and walking barefoot can increase the risk of foot injury
  • Being in warm and moist environments can increase the risk
  • Warts usually occur in winter
  • Exposure to rough surfaces, pressure points, and moist skin can increase the risk of injury or trauma
  • Poor hygiene can induce plantar warts

Complications

Plantar warts cause pain and can hinder the way you stand, walk, or run. It also induces muscle or joint discomfort. 

FAQ’s

How can I prevent Plantar warts?

Avoid contact with infected people. Wear shoes in shared areas. Keep your feet dry by changing your socks every day.

How common are Plantar warts?

Plantar warts mostly affect people aged 12-16, with no gender difference, but Whites have a higher occurrence than Blacks or Asians.

Are Plantar warts contagious?

Yes. The risk of getting warts increases when you touch someone who has warts.

What can I expect if I have plantar warts?

Plantar warts can cause foot pain in high-pressure areas, like the heel or ball of the foot. This discomfort can make walking and running uncomfortable. Although they are not typically serious.

When should I see a doctor?

Seek medical help if you spot signs of infection or other complications.

Summary

Plantar warts frequently occur on the soles of feet and are caused by human papilloma virus (HPV). Plantar warts feel rough and have little black dots. Inward growth can cause pain and discomfort. There are several treatment options for this condition, including self-healing, topical creams, surgical interventions, and other unproven therapies.

Prevention is the most crucial aspect and can be achieved by practicing good foot hygiene. One should avoid contact with the affected person with warts. It is essential to wear protective footwear in public areas.

A healthy immune system can help prevent plantar warts. If your symptoms persist and get worse, see a doctor right away. Large or painful warts also need immediate medical attention. Following these approaches to plantar wart care reduces complications. Maintaining foot health is particularly crucial for individuals with underlying health conditions.

References

  1. Witchey DJ, Witchey NB, Roth-Kauffman MM, Kauffman MK. Plantar warts: Epidemiology, pathophysiology, and clinical management. Journal of Osteopathic Medicine. [Internet]. 2018 [cited 2024 Jan 11]. Vol118(2). Available from: https://www.degruyter.com/document/doi/10.7556/jaoa.2018.024/html
  2. Statpearls. Al AM, Nigam PK. Wart. [Internet] [updated 2019 Sept 27; cited 2024 Jan 11]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431047/
  3. APDerm. Planter Warts. [Internet]. [cited 2024 Jan 11] Available from: https://www.apderm.com/condition/plantar-warts/ 
  4. Cleveland Clinic. Plantar Warts: Symptoms, Causes, Treatment & Removal. [Internet] [updated 2023 Dec 4; cited 2024 Jan 11] Available from: https://my.clevelandclinic.org/health/diseases/24899-plantar-warts
  5. Oakley A. Plantar warts: a Persistently Perplexing Problem. Best Practice Journal. [Internet] 2014 [cited 2024 Jan 11] 65. Available from: https://bpac.org.nz/bpj/2014/december/plantar-warts.aspx
  6. Mayo Clinic. Plantar warts - Diagnosis and treatment. [Internet] [updated 2024 Feb 7, cited 2024 Jan 11] Available from: https://www.mayoclinic.org/diseases-conditions/plantar-warts/diagnosis-treatment/drc-20352697
  7. The Feet People. Plantar Warts. [Internet] [cited 2024 Jan] https://www.thefeetpeople.com.au/symptoms-we-treat/plantar-warts/
  8. University of Michigan Health-Sparrow. Plantar Warts. [Internet] [updated 2024 Feb 6, cited 2024 Jan 11] Available from: https://www.uofmhealthsparrow.org/departments-conditions/conditions/plantar-warts
  9. Intermountain Health. Panko J. Plantar Warts Treatment and Causes. [Internet] [updated 2023 Oct 25; cited 2024 Jan 11] Available from: https://intermountainhealthcare.org/blogs/plantar-warts-treatment-and-causes

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Dr Prerna Yadav

Bachelor of Dental Surgery- BDS, Kothiwal Dental College & Research Centre Moradabad, India

Dr. Prerna Yadav is an accomplished Dental Surgeon with 8 years of clinical expertise. With a passion for knowledge and research, she pursued an Advanced PG Diploma in Pharmacovigilance & Clinical Research. A Certified Medical Writer as well, Prerna possesses a unique blend of dental proficiency and medical communication finesse. Her journey is a testament to dedication and an unwavering commitment to both patient care and advancing medical knowledge.

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