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Closeup of foot with a infected wart placed under toes

The Causes, Symptoms and Treatment of Plantar Warts

Your feet are an extremely hard-working part of your body. Throughout day to day life your feet take an immense amount of punishment and are always at risk from injury and infection. The busier and more active your lifestyle, the greater the risk to your feet. But your feet are not only at risk from hard work and exertion, leisure time can also be surprisingly risky for your feet.

Given that feet are so hard working and vulnerable, it is surprising to know that they are also one of the most neglected parts of the body. They are rarely in your line of vision, and so, are often overlooked when consideration is given to your general health. This neglect can often give rise to injury and infection which could otherwise be avoided. A regular foot complaint, by otherwise healthy individuals, is that of warts, or more precisely, planter warts.

What are Plantar Warts?

Warts are common, unsightly, sometimes painful and can make an individual self-conscious and even withdrawn. Every day, millions of people throughout the world fall victim to, and seek treatment for, this common complaint. Plantar warts, particularly, are found on the feet, usually the soles, hence the name “Plantar”, meaning “Bottom surface”. Research shows that 25% of the UK population will, at some point, suffer from plantar warts.

There are many different types of wart, plantar warts are benign, epithelial tumors caused by a virus, known as human papillomavirus (HPV), of which there are more than 120 strains, and many more sub-strains Some of these strains include those that are associated with sexually transmitted diseases.

The particular strains that cause plantar warts are strains, 1, 2, 4, 27, 57, 60, 63, 65, 66 and 156. These differ from those strains that give rise to warts on other parts of the body, and they are in no way related to the strains that cause genital warts.

HPV enters skin which, for some reason, has been compromised, small cuts or abrasions give the virus access to the stratum corneum. From the initial moment of infection, it may be several weeks or even months before the wart becomes visible. This is because the downward pressure on the foot forces the wart deeper into the skin, and a layer of hard, rough skin develops over the top of it. This patch of hard skin can often be mistaken for a simple callus, with the sufferer not realizing that it is masking an HPV infection.

Plantar warts are normally found on the soles of the feet, particularly the weight bearing areas, but not exclusively. On occasions, plantar warts will manifest themselves on other parts of the foot. The sole of the foot is more vulnerable to infection due to its exposure to surfaces that have become contaminated.

Plantar warts can appear in clusters, which doctors will refer to as recalcitrant planter warts. More commonly, this phenomenon is known as mosaic warts. Although these wart clusters have differing terminology, they are caused by the same strain of HPV. Mosaic warts may result simultaneously from an initial source infecting multiple lesions, or from one infection that spreads, causing satellite warts. Regardless of how these clusters manifest themselves, they are treated in the same way as a single plantar wart.

Mosaic warts also increase the level of discomfort and pain when walking. This can lead to the sufferer walking with an altered gait. Altering the natural way in which you walk put undue pressure on other muscles and joints. This can lead to additional orthopedic problems which may require further medical attention.

Who is Likely to be Infected by HPV?

HPV is non-discriminatory, anyone can be infected by the virus, although some groups of people are at greater risk than others. Children and young adults up to the age of 18 are one such high risk group. This is purely due to the immune system in young people not being fully developed. It is also true that the elderly may have a less robust immune system, but it doesn’t corollate that they are more vulnerable to HPV infection. This is due to the elderly having a less active lifestyle, reducing their exposure to situations where infection risk is high.

Anyone with underlying health problems which erode the efficiency of the immune system would be considered to be at greater risk of HPV exposure infection. Diabetics and HIV sufferers are also at particularly at risk. Certain drugs which are prescribed to cancer patients can also affect the body’s immune system, and thus, increase the risks associated with HPV exposure.

People who undertake any activity that brings about the exposure of the feet will be at risk. Communal showers, locker rooms and public swimming pools are high risk areas. Fine weather activities will often see people going bare foot. Sunbathing in the park or on the beach, outdoor barbeques, or simple play time, all see people shedding their footwear and going barefoot, thus, the exposure risk rises.

The Symptoms of HPV and Plantar Wart Infection

Closeup of foot with a infected wart placed under toes, isolated towards black

The first sign that may indicate the presence, or the onset of, a plantar wart is an area on the foot with hard, thickened skin or callus. This is most commonly on the forefoot, heel and base of the toes. These areas may also appear to have a small black spot at their center, this is sometimes, mistakenly, referred to as the seed. Warts do not actually have a seed; this spot is in fact blood below the skin’s surface.

As the plantar wart develops, the victim may experience discomfort when walking or standing due to the pressure being exerted on the infected area. Plantar warts tend to be painful when pressure is applied to either side of the lesion. This is an important difference to that of a callus which is painful when pressure is applied directly to its center.

This shows how vital it is for everyone to be aware of the condition of their feet. Regular, cursory inspection to look for any abnormalities can often avoid the onset of a more serious problem, and negate the need for a specialist diagnosis and treatment.

Treating Plantar Warts

If left to their own devices, an otherwise healthy person, may well see plantar warts heel and disappear through the body’s immune system fighting the infection. However, only around 20% of plantar warts will have disappeared within 6 months, and around 65% taking up to 2 years. Some HPV infections will refuse to heal and will require professional treatment.

After becoming aware of a plantar wart, most people will look to a pharmacy for a remedy. Here, for the non-professional, potential problems start. There are literally hundreds of products on the market, all of which will claim to be the very best remedy for plantar warts. Of course, some of them are good, and correctly administered they offer a realistic chance of ridding the sufferer of the offending wart. Others are not so good, and to be frank, are a waste of money. The bottom line is, the laymen has no real way of knowing which is the best product for their particular problem.

Over the counter products mainly fall into two categories. Perhaps the most popular are ointments, pads, liquids and gels that contain salicylic acid. All of these products rely on the acid softening and dissolving the abnormal skin tissue. Repeated applications, it is said, will eventually dissolve deeper and deeper tissue until it reaches the wart, relieving the sufferer of the problem.

The other main remedy seen at the pharmacy is plantar wart freezing sprays. These sprays contain liquid butane. These products are sprayed directly onto the infected area, the liquid temperature can be as low as minus 100 degrees. This remedy relies on the extremely low temperature to kill the offending tissue. However, these sprays may not freeze deep enough to kill a very deep-seated plantar wart. With freezing sprays, there is also the risk of localized blistering on skin tissue which was otherwise unaffected by the infection.

It should be noted that diabetics and those people suffering with circulatory, immunological or neurological problems should not attempt to self-treat plantar warts and should always seek professional treatment.

There is a very real chance that over the counter remedies fail to rid the sufferer of the wart and the HPV virus. When this is the case, expert diagnostics and treatment becomes vital. Initially, the best way to obtain this service is through your local, independent podiatric practitioner.

A skilled professional will be able to give an exact appraisal of the condition, suggest and administer definitive treatment. Your local podiatrist will have the skills to treat plantar warts with salicylic acid products in a manner in which an untrained individual is unable to do. This also applies to freezing products. Podiatrists have the knowledge to select individual products to suit every individual case. Quite obviously, this will save an individual time, money and suffering.

On occasions, and in extreme cases, a podiatrist may advise a person to seek further medical advice from a doctor. Although this is not common, it may become necessary if a plantar wart has been unresponsive to regular treatment from a podiatrist. In these cases, there are a number of treatments that may be prescribed.

Prevention

As with any medical issue, prevention is better than cure. This is very important for your hard working, often neglected, feet. HPV infection comes from direct or indirect contact with an infected host. Due to the particular strains of HPV that are responsible for planter warts, HPV antiviral inoculations have no effect. So, prevention is down to personal awareness of this issue.

If you already have a plantar wart, keep it covered to minimize the risk of infecting others. When enjoying outdoor activities, think twice whether going barefoot is really necessary. The fine, warm summer months brings about the feel-good factor. Along with this, comes a care free attitude where common sense often gets sidelined.

When taking part in outdoor activities, protect your feet. Keeping a barrier between the soles of your feet and the ground will vastly reduce the risk of your feet coming into contact with harmful viruses. Wear light sandals or flip-flops. Likewise, at the gym, public swimming pools, communal locker rooms and shower areas.

HPV can be contracted from all manner of inanimate objects, so great care must always be taken with exposed feet. Never share towels, clothing or footwear, this is a sure way to increase your risk of contraction. It should be remembered that children are more vulnerable to infection from HPV, so, as adults, think for them and make sure they are protected.

Don’t be Fooled by Folk Law Remedies

For hundreds of years warts have been much maligned and wrapped up in negative superstition. Over the years many, supposed, folk law remedies for plantar warts have evolved and been passed down from generation to generation.

These vary from rubbing with cider vinegar, dandelion juice, dried corn kernels or maple wood, not to mention a live toad! These are the sort of tales that might have been advocated by your great grandmother, but there are more modern folk tale remedies.

The most common of these is the use of strong self-adhesive tape put over the wart, then removed and replaced daily. It should be noted that none of these, so called, remedies have any scientific basis and there is no proof of any of them aiding in the demise of plantar warts.

If you believe that you may have an HPV infection, early professional advice and diagnosis is by far your best option. Regardless of any well-intentioned advice based on folk law or superstition, you are far better off trusting in medical science.

Young woman with beautiful feet

You first port of call should be your local independent podiatric clinic, such as Feet@theclinic, Loughborough. Such clinics have skilled professionals that can definitively diagnose plantar warts, their severity and the correct treatment for each individual case. Being local, they are also convenient. There are now hundreds of local, private podiatric clinics up and down the country staffed by highly trained professionals, it makes perfect sense to tap into this pool of local podiatric skills.

Local, private clinics will not only diagnose and administer treatment, they will also offer the appropriate ongoing and after care that may be required. With their skills and knowledge, they are also ideally placed to give sound advice on home based, self-care and prevention, reiterating the fact that prevention is better than cure.

 

 

 

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Rebekah Henning is a Foot Health Professional (FHP) who has gone through specialized training at The SMAE Institute based in Maidenhead. She is fully trained and qualified in both the theoretical and practical aspects of foot health and care to enable her to assess the condition of your feet and treat as appropriate, referring you if necessary. She provides routine foot care and maintenance for your feet using the latest procedures and techniques to ensure that you receive the best possible treatment. Her knowledge and skills are up to date by undertaking continual professional development and she is also a Member of the British Association of Foot Health Professionals (MAFHP) and a Member of the College of Foot Health Professionals (MCFHP).

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