Plantar Warts

Evaluation:

Important items to consider in the history:

• Etiology: viral (human papilloma virus)

• Painful, hyperkeratotic lesion, especially with lateral (squeeze) pressure.

• History of trauma to skin (most commonly a laceration or puncture wound).

• Duration: ideal if treated within the first 6 months of appearance.

• Pain with weight bearing, especially after rest.

Differential Diagnosis:

• Plantar verruca (wart)

• Intractable plantar keratosis (callous)

  • No skin line deviation through callous.

  • Not vascular.

  • Always in weight bearing area.

• Porokeratosis (obstructed sweat gland)

  • Skin line deviation around callous

  • Not vascular

  • Usually not in weight bearing area

Physical exam should show a plantar callous with skin lines deviating around a nucleated core.  A wart will also be painful on lateral pressure (squeeze).  Due to the histology and the invasion of the virus into the skin, the lesion is very vascular and debridement will cause pinpoint capillary bleeding.  Since this is a skin condition and not a mechanical (friction, obstruction) injury, the lesions do not have to be in a weight bearing area.  The black spots are thrombosed capillaries, as this is a vascular lesion.

Treatment:

• Unlike other hyperkeratotic lesions, mechanical debridement is not enough.

• Most effective treatment occurs within the first 6 months of appearance of lesion.

• Debride to pinpoint bleeding base with sterile scalpel blade.

• Ablation of residual wart tissue:

  • Chemical - TCA

  • Electrical - Hyfercator

  • Physical – freezing

  • Laser methods).

• May require multiple treatments.

• Surgical excision may re required if intractable.

Christopher Kardohely, DPM and Scott D. Flinn, MD

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*This web version is provided by The Brookside Associates, LLC.  It contains original contents from the official US Navy NAVMED P-5139, but has been reformatted for web access and includes advertising and links that were not present in the original version. The medical information presented was reviewed and felt to be accurate in 2001. Medical knowledge and practice methods may have changed since that time. Some links may no longer be active. This web version has not been approved by the Department of the Navy or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the US Department of Defense or the Brookside Associates. The Brookside Associates is a private organization, not affiliated with the United States Department of Defense.

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