In this section Cypress Foot and Ankle expert Dr. Christopher Correa discusses Plantar warts. Warts are caused by an invasion of a virus known as the Human Papilloma virus into the germinal layer of the skin through cuts or abrasions. Once inside, the virus hijacks the skin cells and immediately and rapidly begins to wall itself off from the rest of the body. It does this to prevent the body’s natural defense system, the white blood cells, from entering the area and discovering the infected cells and subsequently removing them. Clinically plantar warts present on the bottom surface of the feet and typically take the form of a callus. The wart then stimulates the skin cells to divided at a higher-than-normal rate leading to a callus like formation. This abnormal wart tissue also stimulates irregular growth of the underlying blood vessels to increase local blood supply and allow for faster growth/ replication. The affected small vessels normally travel parallel just beneath the skin but, in wart infected tissue it causes the blood vessels grow in an undulating fashion leading to perforation into higher levels of skin. This is why when you look at wart tissue the base is littered with little black dots throughout – These black dots are made up of abnormal vessels which are not present in regular calluses. Additionally, this is why wart tissue tends to bleed a lot when cut. These changes can be seen in the skin even without debridement. Another defining characteristic are aberrations in the natural skin lines which normally flow through the palms and soles of the feet and are readily visible to the naked eye. As the wart forms the lines begin to noticeably reform around the wart infected tissue leaving an appearance of “island in the ocean” where the skin lines flow around the wart tissue.
Generally speaking, infections are “picked up” in places where people may walk barefoot such as public showers, gyms, locker rooms, pools, HOTEL ROOMS, outdoors etc. These are all very similar places to where nail fungus and athlete’s foot infections can occur – more on that in another blog post. Warts can be painful or painless and may or may not form satellites creating a singularly enlarged wart or many smaller warts that spread out over a large area. Generally, we recommend treating warts because they may spread to other areas of the foot over time. While they may not be painful today, they may be at a later time. If new warts form in more sensitive areas such as the ball of the foot or in between a pair of toes. Both conservative and surgical treatments exist for warts.
Treatment of Plantar Warts
Conservative care – Due to the fact that warts exist inside human cells it is not feasible to create a medication that can destroy only the wart tissue without causing damage to normal healthy cells. Due to this conservative treatment revolves around local irritation with various methods to disrupt the basement membrane underneath the wart and allow white blood cells to slip passed the barrier and eradicate the infected cells. This is usually accomplished with a combination of over-the-counter products and home remedies. Such things are salicylic acid, Duck-Tape, Freezing, local debridement (picking at it), mixtures with apple cider vinegar and more. Alternatively, over the counter freezing kits exist and your primary care doctor may even suggest freezing the wart off with liquid nitrogen. All of these methods serve to do the same thing and as a result all usually require multiple weeks of diligent use to be successful.
New modalities like Laser cauterization and Swift Microwave technology have recently been added to the armamentarium and have proven to be highly effective against warts.
Surgical – There are two broad categories of which I am calling Mechanical and Chemical. Mechanical is done by a process known as exchochleation. This is where a blade or a tissue nipper as much wart infected tissue is removed as possible followed up by directly destroying any remaining wart tissue. This latter step is most commonly done with a powerful acid known as Phenol 89%, electric cautery, or with a specialized laser used to burn the base of the wound. This method has proven to be quick and effective.
Chemical – My preferred method is to use a chemical known as Cantheradin. This chemical is an extract from a beetle and when applied directly to the skin creates a blister. This blister separates the wart infected tissue from the normal tissue over the course of a few days. After 1-2 weeks the patient returns, and the blister is removed along with the wart tissue. Once the procedure is complete the area is covered with a band aid and the patient is back to activity pain free in the vast majority of cases. This process is quick and usually minimally painful.
Laser - As previously mentioned laser has been used to stimulate the immune response and painlessly eradicate warts over the course of a few weeks. This is done by increasing the local energy of the cells in the infected region allowing for the normal healing procedures of the body to occur at a faster rate.
Swift - Swift is a machine that delivers low dose microwave energy through a specialized probe that stimulates your body's natural immune response. Once the immune system has cleared the HPV virus the lesions resolve with relatively little pain compared to laser and surgical treatments.
Warts should be treated and eradicated because if left untreated they can begin to multiply and spread to large portions of the plantar surface of the foot. Circa 2017 I had a patient once who ignored her symptoms for the better part of 14 months and when she finally came in to see me she had 92 warts between both feet. What brought her in? She was getting married soon and wanted to be pain free on her wedding day. I am happy to report that without a trip to the operating room we were able to cure that young lady of her warts over the course of 8 weeks. Lucky for most people their symptoms are not this severe. If you have warts and would like them gone give the experts at Select Foot and Ankle Specialists a call today and schedule a consultation!
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