Plantar wart overview

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

A plantar wart is a wart caused by the human papilloma virus (HPV). It is a small lesion that appears on the sole of the foot (hence the name, from Latin planta pedis, the sole of the foot) and typically resembles a cauliflower. A plantar wart may have small black specks within it that ooze blood when the surface is shaved; these are abnormal capillaries. Though the name plantar wart describes specifically HPV infection on the sole of the foot, infection by the virus is possible anywhere on the body and common especially on the palm of the hand, where the appearance of the wart is often exactly as described above for plantar warts. Because of pressure on the sole of the foot, a layer of hard skin forms over the wart. A plantar wart may or may not be painful. It can be spread in communal showers, around swimming pools, by sharing shoes, etc.

Pathophysiology

The human papilloma virus types 1, 2, 4, or 63 are classified as clinical (visible symptoms). The virus attacks the skin through direct contact, entering through possibly tiny cuts and abrasions in the stratum corneum (outermost layer of skin). After infection, warts may not become visible for several weeks or months. Because of pressure on the sole of the foot, the wart is pushed inward and a layer of hard skin may form over the wart. A plantar wart may be painful. Warts may spread through autoinoculation, by infecting nearby skin or by infecting walking surfaces. They may fuse or develop into clusters called mosaic warts.

Causes

Plantar warts are benign epithelial tumors caused by infection by human papilloma virus types 1, 2, 4, or 63. All warts can spread from one part of your own body to another. They may spread from one person to another, but this is uncommon. Infection typically occurs on moist walking surfaces such as showers, swimming pools, or shoes. The virus can survive many months without a host, making it highly contagious.

Epidemiology and Demographics

It is estimated that 7-10% of the US population is infected. Plantar warts tend to affect only 0.29% of people who have never worn shoes.[1]

Diagnosis

History and Symptoms

Common warts tend to cause no discomfort unless they are in areas of repeated friction or pressure. Plantar warts, for example, can become extremely painful. Large numbers of plantar warts on the foot may cause difficulty walking or running. Some warts will disappear without treatment, although it can sometimes take a couple of years. Treated or not, warts that go away often reappear.

Physical Examination

The typical wart is a raised round or oval growth on the skin with a rough surface. Compared with the surrounding normal skin, warts may appear light, dark, or black (rare). Most adults are familiar with the look of a typical wart and have little trouble recognizing it. Unusual warts with smooth surfaces or flat warts in children may be more difficult for parents to recognize.

Treatment

Medical Therapy

No treatment in common use is 100% effective. The most comprehensive medical review found that no treatment method was more than 73% effective and using a placebo had a 27% average success rate. All warts can spread from one part of your own body to another. Unsightly or painful warts can be treated. Warts around and under your nails are much more difficult to cure than warts in other places.

Prevention

Although immunization is available for the HPV and strains causing cervical cancer and venereal warts, there is currently no vaccination treatment for plantar warts.

References

  1. SHULMAN, Pod.D,, SAMUEL B. (1949). "Survey in China and India of Feet That Have Never Worn Shoes". The Journal of the National Association of Chiropodists. Retrieved 27 September 2012.



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