A plantar wart, or verruca vulgaris, is a wart occurring on the

bottom Bottom may refer to: Anatomy and sex * Bottom (BDSM), the partner in a BDSM who takes the passive, receiving, or obedient role, to that of the top or dominant * Bottom (sex), a term used by gay couples and BDSM * Buttocks or bottom, part of th ...

of the

foot The foot ( : feet) is an anatomical structure found in many vertebrates. It is the terminal portion of a limb which bears weight and allows locomotion. In many animals with feet, the foot is a separate organ at the terminal part of the leg made ...

toe Toes are the digits (fingers) of the foot of a tetrapod. Animal species such as cats that walk on their toes are described as being ''digitigrade''. Humans, and other animals that walk on the soles of their feet, are described as being ''plant ...

s. Its color is typically similar to that of the

skin Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation. Other cuticle, animal coverings, such as the arthropod exoskeleton, have diffe ...

. Small black dots often occur on the surface. One or more may occur in an area. They may result in pain with pressure such that walking is difficult. They are caused by the

human papillomavirus Human papillomavirus infection (HPV infection) is caused by a DNA virus from the ''Papillomaviridae'' family. Many HPV infections cause no symptoms and 90% resolve spontaneously within two years. In some cases, an HPV infection persists and res ...

(HPV). A break in the skin is required for infection to occur. Risk factors include use of communal showers, having had prior warts, and

poor immune function Immunosuppression is a reduction of the activation or efficacy of the immune system. Some portions of the immune system itself have immunosuppressive effects on other parts of the immune system, and immunosuppression may occur as an adverse reacti ...

. Diagnosis is typically based on symptoms. Treatment is only needed if it is causing symptoms. This may include

salicylic acid Salicylic acid is an organic compound with the formula HOC6H4CO2H. A colorless, bitter-tasting solid, it is a precursor to and a metabolite of aspirin (acetylsalicylic acid). It is a plant hormone, and has been listed by the EPA Toxic Substance ...

, cryotherapy, chemo-based

fluorouracil Fluorouracil (5-FU), sold under the brand name Adrucil among others, is a cytotoxic chemotherapy medication used to treat cancer. By intravenous injection it is used for treatment of colorectal cancer, oesophageal cancer, stomach cancer, pancreat ...

bleomycin -13- (1''H''-imidazol-5-yl)methyl9-hydroxy-5- 1''R'')-1-hydroxyethyl8,10-dimethyl-4,7,12,15-tetraoxo-3,6,11,14-tetraazapentadec-1-yl}-2,4'-bi-1,3-thiazol-4-yl)carbonyl]amino}propyl)(dimethyl)sulfonium , chemical_formula = , C=55 , H=84 , N=1 ...

, and surgical removal. The skin atop the lesion should generally be removed before treatment. In about a third to two-thirds of cases, they go away without specific treatment, but this may take a few years. Plantar warts are common. Children and young adults are most often affected.

Signs and symptoms

Their colors are typically similar to that of the nearby

. Small, black dots may occur on their surfaces. One or more may occur in an area. They may result in pain with pressure such that walking may be difficult. Veruca right foot detail.jpg, A plantar wart: striae (

fingerprint A fingerprint is an impression left by the friction ridges of a human finger. The recovery of partial fingerprints from a crime scene is an important method of forensic science. Moisture and grease on a finger result in fingerprints on surfac ...

s) go around the lesion. File:Plantarwartscluster.jpg, Mosaic wart cluster File:Wart-IMG 1676.JPG, Young plantar warts File:30 year old plantar wart.jpg, 30-year-old plantar wart File:Painful plantar warts.jpg, Deep, painful plantar warts File:Plantar wart at heel.jpg, Deep plantar wart on heel

Cause

Plantar warts are benign

epithelial Epithelium or epithelial tissue is one of the four basic types of animal tissue, along with connective tissue, muscle tissue and nervous tissue. It is a thin, continuous, protective layer of compactly packed cells with a little intercellula ...

tumors A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...

generally caused by infection by

types 1, 2, 4, 60, or 63, but have also been caused by types 57, 65, 66, and 156. These types are classified as clinical (visible symptoms). The virus attacks compromised skin through direct contact, possibly entering through tiny cuts and abrasions in the

stratum corneum The stratum corneum (Latin for 'horny layer') is the outermost layer of the epidermis. The human stratum corneum comprises several levels of flattened corneocytes that are divided into two layers: the ''stratum disjunctum'' and ''stratum compact ...

(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 or

finger A finger is a limb of the body and a type of digit, an organ of manipulation and sensation found in the hands of most of the Tetrapods, so also with humans and other primates. Most land vertebrates have five fingers ( Pentadactyly). Chambers ...

, the wart is pushed inward and a layer of hard skin may form over the wart. A plantar wart can be painful if left untreated. Warts may spread through

autoinoculation Autoinoculation is derived from the Latin root words "autos" and "inoculate" that mean "self implanting" or "self infection" or "implanting something from oneself". Autoinoculation can refer to both beneficial medical procedures (e.g. vaccination) a ...

, by infecting nearby skin, or by contaminated walking surfaces. They may fuse or develop into clusters called mosaic warts.

Diagnosis

A plantar wart is a small lesion that appears on the surface of the skin and typically resembles a

cauliflower Cauliflower is one of several vegetables in the species ''Brassica oleracea'' in the genus ''Brassica'', which is in the Brassicaceae (or mustard) family. It is an annual plant that reproduces by seed. Typically, only the head is eaten – the ...

, with tiny black

petechia A petechia () is a small red or purple spot (≤4 mm in diameter) that can appear on the skin, conjunctiva, retina, and Mucous membrane, mucous membranes which is caused by haemorrhage of capillaries. The word is derived from Italian , 'freckle,' ...

e (tiny

hemorrhage Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, vag ...

s under the skin) in the center. Pinpoint bleeding may occur when these are scratched. Plantar warts occur on the soles of feet and toes. They may be painful when standing or walking. Plantar warts are often similar to calluses or corns, but can be differentiated by close observation of skin striations. Feet are covered in friction ridges, which are akin to

s of the feet. Friction ridges are disrupted by plantar warts; if the lesion is not a plantar wart, the striations continue across the top layer of the skin. Plantar warts tend to be painful on application of pressure from either side of the lesion rather than direct pressure, unlike calluses (which tend to be painful on direct pressure, instead).

Prevention

HPV is spread by direct and indirect contact from an infected host. Avoiding direct contact with contaminated surfaces such as communal changing rooms and shower floors and benches, avoiding sharing of shoes and socks and avoiding contact with warts on other parts of the body and on the bodies of others may help reduce the spread of infection. Infection is less common among adults than children. As all warts are contagious, precautions should be taken to avoid spreading them. Recommendations include: * Cover them with an adhesive bandage while swimming * Wear latex swimming socks * Wear

flip-flops Flip-flops are a type of light sandal, typically worn as a form of casual footwear. They consist of a flat sole held loosely on the foot by a Y-shaped strap known as a toe thong that passes between the first and second toes and around both side ...

when using communal showers * Do not share towels. Plantar warts are not prevented by inoculation with

HPV vaccine Human papillomavirus (HPV) vaccines are vaccines that prevent infection by certain types of human papillomavirus (HPV). Available HPV vaccines protect against either two, four, or nine types of HPV. All HPV vaccines protect against at least HP ...

s because the warts are caused by different strains of HPV. Gardasil protects against strains 6, 11, 16, and 18, and Cervarix protects against 16 and 18, whereas plantar warts are caused by strains 1, 2, 4, and 63.

Treatment

A number of treatments have been found to be effective. A 2012 review of different treatments for skin warts in otherwise healthy people concluded modest benefit from salicylic acid, and cryotherapy appears similar to salicylic acid.

Medications

Salicylic acid, the

treatment of warts by keratolysis Keratolysis is the removal of dead surface skin cells and is a treatment for several types of wart. The most common keratolytic treatment of warts available over-the-counter involves salicylic acid. These products are readily available at most drug ...

, involves the peeling away of dead surface skin cells with

keratolytic Keratolytic () therapy is a type of medical treatment to remove warts, calluses and other lesions in which the epidermis produces excess skin. In this therapy, acidic topical medicines, such as Whitfield's ointment or Jessner's solution, are ap ...

chemicals such as salicylic acid or trichloroacetic acid. These are available in over-the-counter products, or in higher concentrations, may need to be prescribed by a physician. A 12-week daily treatment with salicylic acid has been shown to lead to a complete clearance of warts in 10–15% of the cases.

Formic acid Formic acid (), systematically named methanoic acid, is the simplest carboxylic acid, and has the chemical formula HCOOH and structure . It is an important intermediate in chemical synthesis and occurs naturally, most notably in some ants. Es ...

, topical, is a common treatment for plantar warts, which works by being applied over a period of time, causing the body to reject the wart.

Fluorouracil Fluorouracil (5-FU), sold under the brand name Adrucil among others, is a cytotoxic chemotherapy medication used to treat cancer. By intravenous injection it is used for treatment of colorectal cancer, oesophageal cancer, stomach cancer, pancreat ...

cream, a

chemotherapy Chemotherapy (often abbreviated to chemo and sometimes CTX or CTx) is a type of cancer treatment that uses one or more anti-cancer drugs (chemotherapeutic agents or alkylating agents) as part of a standardized chemotherapy regimen. Chemotherap ...

agent sometimes used to treat skin cancer, can be used on particularly resistant warts, by blocking

viral Viral means "relating to viruses" (small infectious agents). Viral may also refer to: Viral behavior, or virality Memetic behavior likened that of a virus, for example: * Viral marketing, the use of existing social networks to spread a marke ...

DNA and

RNA Ribonucleic acid (RNA) is a polymeric molecule essential in various biological roles in coding, decoding, regulation and expression of genes. RNA and deoxyribonucleic acid ( DNA) are nucleic acids. Along with lipids, proteins, and carbohydra ...

production and repair.

Bleomycin -13- (1''H''-imidazol-5-yl)methyl9-hydroxy-5- 1''R'')-1-hydroxyethyl8,10-dimethyl-4,7,12,15-tetraoxo-3,6,11,14-tetraazapentadec-1-yl}-2,4'-bi-1,3-thiazol-4-yl)carbonyl]amino}propyl)(dimethyl)sulfonium , chemical_formula = , C=55 , H=84 , N=1 ...

, a more potent chemotherapy drug, can be injected into deep warts, destroying the viral DNA or RNA. Bleomycin is notably not US

FDA The United States Food and Drug Administration (FDA or US FDA) is a federal agency of the Department of Health and Human Services. The FDA is responsible for protecting and promoting public health through the control and supervision of food s ...

approved for this purpose. Possible side effects include

necrosis Necrosis () is a form of cell injury which results in the premature death of cells in living tissue by autolysis. Necrosis is caused by factors external to the cell or tissue, such as infection, or trauma which result in the unregulated dige ...

of the digits, nail loss, and

Raynaud syndrome Raynaud syndrome, also known as Raynaud's phenomenon, eponymously named after the physician Auguste Gabriel Maurice Raynaud, who first described it in his doctoral thesis in 1862, is a medical condition in which the spasm of small arteries cau ...

. The usual treatment is one or two injections. Immunotherapy, as intralesional injection of

antigen In immunology, an antigen (Ag) is a molecule or molecular structure or any foreign particulate matter or a pollen grain that can bind to a specific antibody or T-cell receptor. The presence of antigens in the body may trigger an immune response. ...

s (

mumps MUMPS ("Massachusetts General Hospital Utility Multi-Programming System"), or M, is an imperative, high-level programming language with an integrated transaction processing key–value database. It was originally developed at Massachusetts Gener ...

, '' candida'' or trichophytin antigens USP), is a wart treatment that may trigger a host immune response to the wart virus, resulting in wart resolution. It is now recommended as a second-line therapy.

Surgery

Liquid nitrogen Liquid nitrogen—LN2—is nitrogen in a liquid state at low temperature. Liquid nitrogen has a boiling point of about . It is produced industrially by fractional distillation of liquid air. It is a colorless, low viscosity liquid that is wide ...

and similar cryosurgery methods are common surgical treatments, which act by freezing the external cell structure of the warts, destroying the live tissue.

Electrodesiccation Cauterization (or cauterisation, or cautery) is a medical practice or technique of burning a part of a body to remove or close off a part of it. It destroys some tissue in an attempt to mitigate bleeding and damage, remove an undesired growth, or ...

and surgical excision may produce scarring. Laser surgery is generally a last resort treatment, as it is expensive and painful, but may be necessary for large, hard-to-cure warts."Laser Surgery for Warts"
webmd.com

Cauterization Cauterization (or cauterisation, or cautery) is a medical practice or technique of burning a part of a body to remove or close off a part of it. It destroys some tissue in an attempt to mitigate bleeding and damage, remove an undesired growth, or ...

may be effective as a prolonged treatment. As a short-term treatment, cauterization of the base with anesthetic can be effective, but this method risks scarring or

keloid Keloid, also known as keloid disorder and keloidal scar, is the formation of a type of scar which, depending on its maturity, is composed mainly of either type III (early) or type I (late) collagen. It is a result of an overgrowth of granulation t ...

s. Subsequent surgical removal, if necessary, also risks keloids and/or recurrence in the operative scar.

References

External links

Plantar warts
at the

Mayo Clinic The Mayo Clinic () is a nonprofit American academic medical center focused on integrated health care, education, and research. It employs over 4,500 physicians and scientists, along with another 58,400 administrative and allied health staff, ...

website
Warts
at '' Merck Manual'' {{DEFAULTSORT:Plantar Wart Virus-related cutaneous conditions Foot diseases Papillomavirus-associated diseases Wikipedia medicine articles ready to translate