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Verrucae, commonly known as plantar warts, are contagious growths that occur due to infection with the human papillomavirus (HPV). (1) Plantar warts affect about 10% of the population and have a 10%–20% prevalence among school-aged children. (2)(3)
Plantar warts can appear in people of all ages and gender, especially people with a weak immune system, children, and those who have been affected by plantar warts before.
Treating plantar warts can be quite difficult as the infection may fester beneath the skin even after the wart is removed, leading to re-formation of the warts after weeks or months. In most cases, the warts resolve on their own and do not warrant removal, especially if they are painless.
This article talks about different medical and at-home treatments for the removal of plantar warts and cases that require medical assistance.
Symptoms of Plantar Warts
HPV infections are easily contracted in warm, moist places, such as near swimming pools, since the virus grows easily in such places. If you have a crack, cut, or opening in your feet, the virus can enter the skin easily, leading to plantar warts.
Generally appearing on the toes or soles of the feet, these warts present as flat yellow spots on the skin, with a depression, crust, or black spot in the center. The warts may occur singularly or in clusters, known as mosaic warts.
Most warts are painless, but they can cause great discomfort when present on weight-bearing areas. Also, the pressure on your feet while walking may lead to an inward growth of warts below the thick, hard skin, making them more painful.
Medical Treatment for Plantar Warts
Most cases of verrucae can be left untreated, as the warts generally resolve on their own without any blemish or scar. However, for persistent warts, known as recalcitrant warts, treatment is essential.
Treating plantar warts is time consuming and tough. In fact, some treatments for wart removal may be painful, such as those involving liquid nitrogen. Moreover, treating a plantar wart does not prevent recurrence.
Different treatments for warts have their pros and cons, which you must discuss with your doctor. Keep in mind that if you have a weak immune system or taking immunosuppressant medications, you may not respond to treatment as well as others.
You can talk to your doctor about the following treatment modalities if you have painful or discomforting plantar warts:
1. Cantharidin
Applying a layer of cantharidin on the wart can help develop a blister underneath the wart. This causes the wart to die in a week, which can then be clipped off by the doctor.
2. Electrosurgery
Electrosurgery, also known as electrodesiccation, refers to burning the plantar warts using an electric needle after numbing the area with anesthesia.
3. Curettage
A sharp knife or spoon-shaped tool is used to cut or scrape off the wart. However, with this treatment, there are high chances of scarring and recurrence.
4. Cryotherapy
Using liquid nitrogen, the wart is frozen and then removed. However, if you have a thick wart, it may need to be shaved first. This treatment may require to be repeated monthly. Your doctor may also use salicylic acid in between freezes to improve the efficacy of the treatment, which otherwise is low.
5. Photodynamic therapies
Hard-to-remove warts can be treated with pulse dye or long-pulsed Nd:YAG laser surgery. (4)
6. Immunotherapy
Your doctor may inject candida antigen, interferon, or diphencyprone to induce an immune response, boosting your immune system to act against HPV. This method eliminates multiple warts at a time from the skin.
7. Chemical peeling
Beta hydroxy acids such as salicylic acid are used to remove the wart layer by layer. For this, the feet are soaked in warm water and the now soft, thick skin is exfoliated using a pumice stone or emery board.
Following this, salicylic acid-based gel or paint is applied to the wart. The treatment can last up to 12 weeks.
8. Hyperthermia therapy
The affected foot is soaked in hot water (45°C to 48°C) to heat-kill the plantar wart cells. (5)
9. Other treatments
Other oral (6) and topical treatments (7) may be used to remove plantar warts, some of which may be used together as combination therapy. (5) These treatments include:
- Zinc sulfate and oxide ointments
- Imiquimod
- Formaldehyde gel
- Podophyllotoxin
- 5-Fluorouracil
- Bleomycin injections
- Glutaraldehyde
- Topical retinoids
- Dithranol
- Acetic acid
- Intralesional vitamin D injection
- Silver nitrate caustic pencils
Note:
- Silver nitrate pencils are moistened and applied to the warts for a couple of minutes. It can stain the surrounding skin or clothing and also comes with a risk of mild chemical burns.
- Fluorouracil cream is an off-label treatment for plantar warts but has been found to be safe in a few studies. (8) It should be used with caution as it can cause blistering, local irritation, and even nail detachment if used close to the nail.
Home Remedies for Plantar Warts
Up to 65% of cases of plantar warts resolve in 2 years without any treatment. Therefore, warts that don’t cause pain or other symptoms can be left untreated.
If you seek treatment, it is best to get a proper diagnosis from a doctor and take his/her advice on home treatments as there is an involved risk of damaging the surrounding skin and bacterial infections.
You can try the following home remedies on approval from your doctor:
1. Use duct tape
Although there is limited evidence to the efficacy of duct tape use for plantar warts, it is generally safe and well tolerated.
How to use:
- Apply silver duct tape to the wart and leave it on for 4–7 days.
- Remove the tape and clean the area using soap and water.
- Exfoliate the affected area with an emery board, avoiding the surrounding skin.
- Cover the wart with another piece of duct tape after 12 hours.
- Repeat this remedy for up to 6 weeks. (9)
2. Apply oils
Natural plant oils such as tea tree oil, thuja oil, (10) neem oil, (11) and lemon essential oil have antimicrobial and antiviral properties that can help in the treatment of warts.
The use of these oils has been supported by scientific studies (12) and anecdotal evidence as well.
How to use:
- Dilute the essential oil with a carrier oil such as vitamin E oil.
- Apply the oil blend to the warts.
3. Use garlic topically
Garlic contains antiviral compounds that can inhibit the growth of virus-infected cells, (13) thus contributing to the treatment of HPV infection and warts.
How to use:
- Crush a clove of garlic and apply it directly to the affected area.
- Cover it with the area with a bandage.
- Wash the area after 20 minutes of application.
4. Dab some lemon juice
A study demonstrated that the use of 50% citric acid solution can help in clearing warts. (14) Since lemons are rich in citric acid, they may have a similar effect.
How to use:
- Squeeze a lemon and dilute the freshly extracted juice with some water.
- Dab the solution on the affected area using a cotton ball.
- Cover the area with a bandage.
5. Use topical colloidal silver
The use of silver-based ointments is common in the treatment of warts. Therefore, colloidal silver can be used as a home remedy, but with caution.
How to use:
- Soak a cotton pad or swab with colloidal silver and apply it to the affected area.
- Apply a piece of duct tape over it.
- Cleanse the area the morning after, and then gently scrub the area using a pumice stone.
6. Apply apple cider vinegar
Applying cider vinegar (ACV) to plantar warts has been anecdotally used in the treatment of plantar warts, although there is no scientific evidence to it. It is suggested that ACV may act similarly to salicylic acid used for the chemical peeling treatment for warts.
How to use:
- Dilute 1 part ACV with 3 parts water
- Dab the solution on the affected area using a cotton ball.
- Cover the area with a bandage.
7. Cover with a banana peel
The use of banana peel for the treatment of warts is based purely on anecdotal evidence. It is safe to use, provided that you are not allergic to bananas.
How to use:
- Tape a piece of banana peel over your wart, with the inside touching your skin.
- Alternatively, rub a fresh slice of banana on your wart.
It is best to use green banana peels rather than ripe banana peels.
8. Use OTCs
You can also use over-the-counter medications available in the form of gels, ointments, and adhesive pads for the treatment of plantar warts. These products contain compounds such as salicylic acid, vitamin A, (15) zinc oxide or zinc pyrithione, milk thistle extracts, green tea extracts (sinecatechins), and curcumin. (16)
Additionally, freezing aerosol sprays that freeze the affected tissue gradually and kill them can be used for at-home cryotherapy. (17)
Salicylic acid gel (27%) is another common remedy for plantar warts. It is to be used once daily for up to 3 months. Before using this gel, make sure to cover the surrounding area with soft paraffin or a special plaster.
People with diabetes should be cautious while using such products as they may cause foot ulcers.
Caution: Some wart removers are flammable; therefore, they should not be used near a flame, heat sources, fire, and lit cigarettes. Make sure to check the product labels for all precautions.
ALSO READ: Home Remedies for Warts and Self-Care Tips
Self-Care Measures
It is suggested to follow some self-care measures along with the medical treatment to aid in faster recovery and prevent the spread of infection. The following tips may be useful:
1. Do not touch the warts
It is essential to avoid touching the warts directly with your hands to prevent the spread of infection. Similarly, avoid scratching or picking at them. In case you touch the wart, make sure to wash your hands properly.
2. Maintain foot hygiene
Always wear footwear in public places to avoid catching the infection. Keep your foot clean, dry, and moisturized. Also, change your socks daily and clean your shoes once in a while.
3. Cover the warts
Use waterproof plasters or rubber verruca socks to cover the plantar warts when entering water bodies such as swimming pools.
4. Use comfortable footwear
It is essential to wear comfortable and properly fitting shoes. You can also use special orthotic pads that help relieve pressure off your warts. Avoid sharing your socks and shoes with anyone else.
5. Sterilize used tools
After treating your warts, sterilize the tools you use with boiling water or alcohol. In addition, avoid using the tools, such as an emery board, on other parts of the skin to prevent the spread of infection. Dispose of the skin fillings hygienically.
6. Do not clip your warts
Avoid using nail clippers to remove your warts as it can cause infection and scarring.
7. Include immunity-boosting foods in your diet
It is suggested to add antiviral foods such as garlic to aid in the treatment of plantar warts. Consume vitamin A-rich foods such as broccoli, sweet potatoes, carrots, red bell peppers, spinach, and apricots as they boost the immune system.
Additionally, vitamin C helps in the formation of antibodies and can be obtained through grapefruit, tangerine, oranges, papaya, strawberries, tomato juice, bell pepper, and vitamin C-fortified cereals. You should also eat foods containing zinc, copper, iron, and selenium such as beans, seeds, whole grains, nuts, and seafood to strengthen your immune system.
When to See a Doctor
Plantar warts generally do not warrant medical treatment as they rarely cause complications. However, they may be a source of embarrassment or stress, which requires equal attention.
You must consult your doctor in the following cases:
- The wart is painful, darkening, or bleeding.
- The affected area is swollen or has drainage.
- The wart is persistent, recurring, or multiplies.
- The wart causes discomfort in daily activities.
- You have diabetes or loss of sensation in the feet.
- You have a weak immune system due to conditions such as HIV/AIDS and immune system disorders or as a result of immune-suppressing drugs.
Plantar warts are generally benign, but in a few cases, especially in immunosuppressed people, prolonged cases of warts may turn cancerous, leading to squamous cell carcinoma or plantar verrucous carcinoma. (18)
Most-Asked Questions About Plantar Warts
How can one differentiate a wart from a foot corn?
Foot corns are round outgrowths that develop on the sole of the foot due to the accumulation of hard skin. However, these outgrowths have smoother edges and overall appearance than a wart.
In addition, corns induce pain on direct pressure, whereas warts elicit pain when squeezed from the sides. While warts may bleed arbitrarily, corns only bleed when they are subject to physical damage.
Can plantar warts be prevented with vaccination?
While there is a vaccine available for HPV, it only targets the HPV strains that cause genital warts and cervical cancer. This vaccine is not useful against the HPV strain responsible for plantar warts. It may help prevent recalcitrant plantar warts, but this effect is yet to be studied in clinical trials.
Final Word
Plantar warts, or plantar verrucae, appear after an infection with HPV. These small growths can develop on the soles of your feet, at times causing pain depending on their location and embarrassment due to their appearance.
While you can seek treatment for plantar warts, most cases resolve on their own. You can also use home remedies and OTC medications to facilitate healing. However, the infection may not be cured, leading to the reappearance of the warts.
Therefore, it is best to avoid getting the infection in the first place, which can be done by maintaining hygiene and wearing proper footwear in damp public places. Consult your doctor for proper diagnosis and treatment if you develop plantar warts.
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