Treatment of plantar warts can be very difficult because if even one viral particle remains, the wart can redevelop. In addition, the skin on the bottom of the foot is very thick, giving the virus a lot of room to hide.
Topical: There are many topical chemicals that are used to treat warts. Most are ineffective due to the thick dermal layer on the bottom of the foot. Freezing the wart with liquid nitrogen is still commonly used, but extremely ineffective. We currently use a compounded prescription cream that has proven to be very effective.
Procedures: One of the most effective treatments is injecting a medication directly into the wart. This is done with a needleless injector. This is often just a single treatment, with better than 95% efficacy. Excision of the wart is about 70-80% effective and therefore rarely done in our clinic.
Despite common belief, warts do not go deep. The infected tissue avoids the immune system by staying in the dermis and epidermis. In addition, warts do not produce "seeds". The dark spots are capillaries that extend into the lesion. A callus develops because the wart tissue is more prominent than the surrounding tissue.
There are several different HPV viruses that infect the foot. Some create just single lesions, but some create large patches of wart tissue that can encompass the entire ball of the foot or heel.
Warts are caused by a DNA virus in the family Human Papilloma Virus (HPV). HPV that infects the foot should not be confused with the types that cause cervical cancer. Warts can develop a thick callus on the surface, causing significant pain. Because a wart is caused by a virus it can be challenging to treat.
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