Despite the advanced technology that has occurred in podiatric medicine, the plantar wart remains a very troublesome foot lesion. The name plantar indicates its location on the foot - the plantar (sole) surface. This lesion is caused by a viral infection of the Human Papilloma Virus (HPV). Commonly, these infections have an estimated incubation period of 4 months. The age range of affected persons is usually from the first to third decade of life, with maximum occurrence between the ages of 12 and 16 years. There are many strains of the HPV wart, but it has not shown any malignancy attributes.

As other viral infections are highly contagious, so are warts. In fact, one can auto-inoculate ("self-spread) these lesions. Plantar warts commonly begin in areas of traumatized skin. They are also contracted from communal areas such as locker rooms, bathrooms, and hotel rooms. In order to decrease the spreading of warts to others while in such areas, the use of disinfectants and sandals is encouraged.

The many varieties of warts that exist are named by their appearance or location. Verruca Vulgaris (common wart) is located on the arms, legs, hands, and on the top of feet, where as verruca plantaris is always found on the plantar or sole of the foot. The Plantar wart may be mistaken for a callus on the bottom of the foot. The differentiating characteristic is the presence of pin point bleeding after trimming. These are called Rete Pegs and are diagnostic for warty tissue. A wart is actually a benign skin tumor and the pin point bleeding is due to its rich blood supply. The mosaic wart is so called due to the vast number of warts that appear in a contiguous pattern. The Mater (mother) wart will present itself in the center with small satellite lesions in the periphery.

Warts are known to spread in location, to other locations on the body, and more importantly, to other people. In a few cases, they have also been known to resolve on their own accord. However, treatment is necessary not only to prevent a wart's spreading behavior, but to eliminate it as well.

There are many myths regarding warts. For example, there are no seeds in warts: these are capillary buds (small blood vessels). A wart has no roots. These lesions, like other benign tumors, are well encapsulated and limit the depth of their penetration. They do not adhere to bony tissue. Warts cannot be contracted from toads.

Treatment options for the care of warts are numerous. Not one of these treatments, however, is guaranteed to eradicate the lesions. Warts can be very stubborn and treatment is often costly, as the longer the wart has been in existence, the longer the treatment period. For this reason, it is tantamount to initiate care as quickly as possible. It is also important to note that the number of treatment encounters increases in relationship to the number of lesions.

Treatments vary from patient to patient. Some treatments include topical acids that burn the tissue to destroy the wart. Another treatment is a topical anticancer medication, Efudex. This serves to slow and reverse the wart's growth. At times, liquid Nitrogen is utilized to burn the wart. Surgical curettage (scraping) is often performed to immediately remove the lesion. This includes the application of an acid to the base to burn the cells that may have the viral infection. Surgical use of a laser can be employed, but it offers no advantage over the curetting of a wart. The "Needling Technique" has also been used to eliminate warty lesions. This interesting procedure involves anesthetizing the area and puncturing the lesion with a sterile needle approximately 100-200 times. This promotes bleeding and stimulation of the immune system to recognize the viral infection. This leads to immunization or elimination.

Recently, the use of the oral medication Tagamet has been employed. However, no scientific data exists to support the efficacy of this treatment. In fact, many treatments using psychological powers have been documented. For example, buying the wart for a penny (a person takes a penny from the warty victim, applies it to the wart, and then pockets the penny) has sometimes worked. Another strange, yet textually documented treatment requires that a person take an onion, apply it to the wart, wrap the onion in a favorite "handkerchief" and then bury it in the backyard. If s/he forgets about the wart, it will disappear.

Despite the various treatment options, warts are stubborn, contagious, benign skin tumors that have plagued mankind. They can be extremely recalcitrant to treatments and can reoccur. The best defense against warts is not to ignore them, fore they will spread not only from one area of the body to another, but also from one person to another.

Dr. Graham has been in private practice in Effingham since 1989 and is on staff at St. Anthony's Memorial Hospital and Effingham Ambulatory Surgical Treatment Center. He is Board Certified by the American Board of Podiatric Surgery and American Board of Podiatric Orthopaedics and Primary Podiatric Medicine. Dr. Graham is a Fellow of the American College of Foot and Ankle Surgeons, the American College of Foot and Ankle Orthopaedics and Medicine, and American Professional Wound Care Association. He is also a member of the American Podiatric Medical Association and the Illinois Podiatric Medical Association.

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