Plantar warts, or warts on the bottom of the feet, are caused by a virus. HPV or the Human Papiloma Virus, commonly causes warts throughout the body and is passed only through direct contact. This often occurs in public places (when walking barefoot) such as swimming pools, showers, locker rooms, gymnastics or karate classes. It may also be encountered with poorly cleaned equipment during a pedicure.

The virus is highly contagious and is a common problem encountered primarily by children and adolescents. However, this does not preclude adults (especially the elderly) from also catching the virus. Although warts can not be inherited, the infection often runs in families. This is both because exposure can happen at home and also that certain individuals inherit a tendency for the virus to present as a wart.

Appearance of Plantar Warts

The diagnosis of plantar warts, or warts elsewhere, is usually not too difficult. The most common signs and symptoms of warts include:

Thickening of the Skin: Due to the repetitive stress of walking, plantar warts often resemble calluses and have thick, hard skin covering them.

Pain: Warts are often painful, especially with pressure or when sides of the wart is squeezed.This is especially problematic with plantar warts, as walking or standing can be painful

Spreading: Without treatment, plantar warts generally spread to other areas of the feet or form a larger cluster around the original verruca.

Black Dots: Often you will hear people say "seed warts" or "my wart has seeds". These small black dots seen in the thick tissue making up a wart are the most important feature to diagnosis a wart. These black dots are capillaries (small blood vessels) in the skin that supply the wart. When the top of the wart is removed, little areas bleed (often called "pin-point bleeding") and confirms the diagnosis.

Treatment Options

Although there are many treatments discussed online or even in doctors offices, effectively treating warts can be problematic and especially on the bottom of the foot can have a high rate of failure. At your local pharmacy or grocery store you may find additional treatment options (also often ineffective on thicker skin as found on the bottom of the foot).

That being said, we have found several treatments that are effective:

Topical Treatments: You will find a wide range of topical treatments including creams, pastes and oils. Although many of these treatments are ineffective on the bottom of the foot, they may be effective elsewhere (including on the top of the foot).

Burning or Freezing: This is the most common treatment and can include liquid nitrogen for freezing, acids or lasers for burning and are usually very painful (both during treatment and during recovery). These may work on areas with thinner skin, they almost never work on the bottom of the foot due to inability to burn or freeze deep enough without causing significant damage to surrounding tissues.

Duct Tape: Although we don't know the exact mechanism of action, there is a valuable study that shows efficacy at treating warts (even on the bottom of the foot) by putting large pieces of duct tape over the area and leaving in place for 5-14 days. Longer treatment is more effective. When you remove the tape, it is recommended that you clean the area and then reapply until the warts are no longer visible. This can take anywhere from 3 weeks to 6 months.

Candida Antigen Injection: Although there are a number of injectable treatments for warts, I have found many of them both ineffective and very painful. We treat with a small injection in a single wart with anesthetic and the antigen for candida. This stimulates the body to react to the area and aggressively fight the virus that causes the wart. It is so effective that often in 6 weeks this wart and any other wart on the body (even other places like the hands) will be eliminated. The presentation of healing may initially be very red and swollen but over time the wart either falls off (often in kids) or transforms into a callus that can be trimmed off.

Remember when getting treatment for warts, cutting out should be a treatment of last resort because you aren't eliminating the cause. The Candida Antigen injection is most effective at eliminating the virus in the body.

In rare situations (or if other treatments are failing) we do cut out warts and this too can be very effective!