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Plantar Wart

Plantar wart refers to a wart that forms on the foot caused by the human papillomavirus (HPV).


Presentation

A plantar wart appears on the sole of the foot as a small cauliflower-shaped lesion. There is a central dark spot in the lesion that is in fact a petechial hemorrhage. Scratching of the may result in bleeding. Upon standing or walking, pain is felt at the site of the wart.

Pathologist
  • Any wart-like lesion on the sole of the foot that does not resolve after appropriate therapy and continues to enlarge should be biopsied and examined by a pathologist.[emedicinehealth.com]
Chills
  • The clinical course in this patient was characterized by fever, chills and drainage from the injection site. Diagnosis was made by demonstration of noncaseating granulomas on liver biopsy. No acid-fast organisms were identified by stain or culture.[ncbi.nlm.nih.gov]
Foot Pain
  • Common Foot Pain Problems Foot pain may be caused by a variety of problems. See photos of common foot problems, such as corns and calluses, plantar warts, gout, bunions, athlete's foot, hammertoe, ingrown toenails, and flatfoot.[emedicinehealth.com]
  • […] callus) over a well-defined "spot" on the skin, where a wart has grown inward Black pinpoints, which are commonly called wart seeds but are actually small, clotted blood vessels A lesion that interrupts the normal lines and ridges in the skin of your foot[mayoclinic.org]
  • Don’t endure pain unnecessarily—let our team end your foot pain now! Diabetics and patients with autoimmune disorders should never treat foot conditions at home, since serious infections can result.[absolutefootcarelv.com]
Heel Pain
  • Thousands of Aussie kids face common childhood foot problems ranging from delayed walking, heel pain and growing pains through to ingrown toenails.[myfootdr.com.au]
  • Samuel Ghani and Muhammad Ali Fazal, An Unusual Cause of Intractable Heel Pain, The Journal of Foot and Ankle Surgery, 10.1053/j.jfas.2011.06.014, 50, 6, (744-746), (2011).[doi.org]
Ankle Pain
  • I was creating an imbalance that was manifesting as ankle pain and working its way up through the rest of my body.[stubbornwart.blogspot.com]

Workup

Plantar warts can usually be diagnosed simply upon physical examination. Plantar warts are often confused with calluses, however, there is a simple observation that can differentiate them.

In case of plantar warts, the striations of the feet go around the lesion of the wart. On the other hand, in the case of calluses, the striations run straight across the top layer of the skin, even over the lesion.

Liver Biopsy
  • Diagnosis was made by demonstration of noncaseating granulomas on liver biopsy. No acid-fast organisms were identified by stain or culture. The patient responded to antituberculous therapy.[ncbi.nlm.nih.gov]

Treatment

Plantar warts should be treated by medical or surgical interventions if the pain is too much to bear.

  • Keratolytic agents (agents that break down keratin) containing salicyclic acid are the first line of treatment for plantar warts [5] [6]. These agents are often available as over the counter medications. They are used daily for 12 weeks with a complete success rate of 10-15%. Similar agents containing trichloroacetic acid are also equally effective.
  • Immunotherapy is the second line treatment for plantar warts [7] [8]. Antigens that trigger the immune response of the body are injected. The resultant immune response is quite localized to the area of the wart. This often leads to a faster resolution of the lesion.
  • Surgical interventions are considered when other therapies are not effective [9] [10]. Cryosurgery which involves internal freezing of the cells of the warts by the use of liquid nitrogen is one of the frequently used methods. Other methods include surgical excision and removal of the wart, cauterization and laser therapy.

Prognosis

The prognosis of the patients suffering from plantar warts is excellent. In up to 27% of the patients, the disease may resolve on its own without any treatment. In the rest, medical and surgical treatment is associated with a very good cure rate and the patients do not suffer from long term nuisance because of these warts.

Etiology

The causative agent of plantar warts is a virus known as the human papilloma virus (HPV) [1]. There are more than a hundred types of this virus. Out of them, the types that commonly lead to the development of plantar warts include types 1, 2, 4, 60 and 63 [2]. Rarely, plantar warts may be caused by types 57, 65, 66 and 156.

Infection occurs when the virus invades the compromised portions of the skin through direct contact. This may occur when a person with cuts or abrasions walks on moist surfaces such as near showers or swimming pools.

This infection is uncommon in people who always walk barefoot since the soles of such people’s feet become hard and crusty. As shown by a survey in China and India, there is only a 0.29% incidence of plantar warts in people who walk barefoot [3].

Epidemiology

Plantar warts affect around 7 to 10% of the population in the United States. Males and females are affected equally; however, genetic and racial factors play a predisposing role. Certain researches indicate that warts occur two times more commonly in blacks as compared to whites [4].

Sex distribution
Age distribution

Pathophysiology

The invasion and infection of the human papilloma virus in the plantar skin triggers a series of changes that leads to the formation of warts. The exact mechanism of these changes is not very clear; however, it is known to be due to an immune response to the virus.

The primary changes that occur consist of the thickening of several of layers of the skin including the stratum corneum (by deposition of excess of keratin), stratum spinosum and stratum granulosum, as well as elongation of the rete ridges.

Prevention

  • Walking barefoot is known to be an effective preventive measure against the development of plantar warts. Barefoot walking makes the skin of the feet thicker that helps prevent plantar warts.
  • The infection progresses in moist, closed environments due to which it is recommended to avoid wearing shoes immediately after walking barefoot in moist public areas such as pools and showers.
  • Since these warts are contagious, they should not be touched directly. Sharing of socks or shoes with the affected person should also be avoided.
  • According to the British National Health Service, children with warts should wear an adhesive bandage when they swim; wear flip-flops when they use public showers and avoid sharing their towels with anyone else.

Summary

Warts are small, rough growths that develop on the skin. Plantar warts refer to those warts that form on the foot, primarily on the sole. Warts have multifactorial etiology; however, plantar warts in particular are caused by human papilloma virus. Several strains of this virus can cause the development of plantar warts.

The disease is self-limiting and requires only conservative treatment. Complicated cases that fail to respond to conservative treatment may require minor surgical intervention.

Patient Information

Warts that form on the sole of the foot are known as plantar warts. They may have a rough, cauliflower like shape or may resemble a blister. They are formed as a result of infection with several strains of a virus known as human papilloma virus.

Plantar warts often heal on their own and require very limited treatment. Cases that do not heal despite proper treatment may require some minor surgery for the removal of the wart.

References

Article

  1. Tondra JM, Carlin GA. Plantar warts; their etiology and treatment. The American journal of nursing. Jul 1955;55(7):828-829.
  2. Laurent R, Kienzler JL, Croissant O, Orth G. Two anatomoclinical types of warts with plantar localization: specific cytopathogenic effects of papillomavirus. Type I (HPV-1) and type 2 (HPV-2). Archives of dermatological research. 1982;274(1-2):101-111.
  3. Shulman A. Survey in China and India of Feet That Have Never Worn Shoes. The Journal of the National Association of Chiropodists. 1949.
  4. Mallory SB, Baugh LS, Parker RK. Warts in blacks versus whites. Pediatric dermatology. Mar 1991;8(1):91.
  5. Zschocke I, Hartmann A, Schlobe A, Cummerow R, Augustin M. [Efficacy and benefit of a 5-FU/salicylic acid preparation in the therapy of common and plantar warts--systematic literature review and meta-analysis]. Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG. Mar 2004;2(3):187-193.
  6. Le Cleach L, Trinquart L, Penso-Assathiany D, Chosidow O. Comparative effectiveness of cryotherapy and salicylic acid for plantar warts. Archives of dermatology. Nov 2012;148(11):1311-1313.
  7. Gamil H, Elgharib I, Nofal A, Abd-Elaziz T. Intralesional immunotherapy of plantar warts: report of a new antigen combination. Journal of the American Academy of Dermatology. Jul 2010;63(1):40-43.
  8. van der Steen P, van de Kerkhof P, der Kinderen D, van Vlijmen I, Happle R. Clinical and immunohistochemical responses of plantar warts to topical immunotherapy with diphenylcyclopropenone. The Journal of dermatology. Jun 1991;18(6):330-333.
  9. Brown JB, Fryer MP. Repair of surface defects of the foot; resurfacing the foot by plastic surgery for defects such as plantar warts and traumatic, thermal and radiation lesions. Journal of the American Medical Association. Jun 16 1951;146(7):628-633.
  10. Dufourmentel C, Mouly R. [Role of surgery in the treatment of plantar warts & calluses]. La Presse medicale. Oct 1 1958;66(67):1517-1519.

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Last updated: 2019-07-11 22:24