Verrucae are harmless lesions caused by human papilloma virus (HPV) and usually spontaneously resolve in 2-5 years. There are currently more than 100 known types of HPV with the most common being on the hands and feet; subtypes 1, 2 and 4.
This virus is contagious and thrives in warm, moist environments such as swimming pools, changing room floors and bathrooms. If an infected bare foot walks across the poolside, it may release virus-infected cells onto the floor. If you then walk on the same floor, you can pick the virus up, especially if you have any small or invisible cuts and abrasions that make it even easier for the virus to penetrate. You could also catch the virus from an infected towel. Here, the virus remains latent in the cell from 1 to 8 months. The process of virus replication produces proliferation of cells which alters the character of the skin, resulting in the visible warty appearance of the verrucae.
Verruca dry needling has been around since 1969, first founded by G W Faulkner, but to date, only a handful of scientific studies have been conducted to support its efficiency, and even fewer RCTs (randomised control trials) have been explored. Your podiatrist may have given you this information leaflet as another treatment option if all other verruca treatments have failed. You should carefully read all the information contained and if you have any questions, consult your podiatrist.
Who is dry needling suitable for?
The dry needling procedure will only be carried out after an initial assessment determining your suitability based on; age; general health; medical history; duration, location and type of verruca; previous verruca treatments etc. If you are over the age of 18, have had verrucas for over 5 years and have exhausted all other treatment options, then this procedure may be suitable for you.
What will happen during the appointment?
The procedure itself will last 20-30mins but the entire appointment 90mins. Local anaesthetic is administered at the ankle, at the toe or around the verruca according to the location of the lesion chosen for needling. Once the area of skin is anaesthetised, any overlying callus is debrided. If you present with mosaic or multiple plantar warts the largest and thickest lesion is selected for treatment.
The area surrounding the lesion is first cleansed. A needle is used to puncture through the verruca to the skin underneath to stimulate an immune response. Each puncture produces pin point bleeding and is continued until there is no more resistance, or reactive pressure from the skin.
No one treatment can guarantee a cure
The total number of punctures varies according to the size of the lesion. Pressure is then applied to the wound with sterile gauze and dressed with sterile dressing. A felt aperture pad is also applied on weight bearing sites to deflect pressure and reduce post-operative bruising. You will then be issued with a post-operative advice sheet and advised to lightly shower and wash the area after keeping the dressing dry for 24 hours.
After the appointment
- You must not drive following the treatment and for 24 hours after as your foot will be numb.
- You must go home straight after treatment and elevate your foot to minimise any bleeding.
- If you require pain relief, avoid taking anti-inflammatory medication for 48 hours as this will decrease the likelihood of a successful inflammatory response.
- You will be required to return to the clinic the following day for redressing and also 1 week later for wound inspection and removal of any uncomfortable scabbing that may have formed.
- Further follow up appointments at 12 weeks and 24 weeks will also be necessary.
How will I know if treatment has been successful?
Complete resolution is deemed accomplished on return of normal skin pattern to the treated lesion, i.e., uninterrupted skin striae and no pain on lateral compression of the area.
It may be necessary to repeat the procedure 10-16 weeks after the initial procedure. In 50% cases this will be necessary especially if the verruca is very resilient, and/or mosaic.
Current studies have shown dry needling to have a 67% – 69% success rate, with the total verruca resolution 6 months after the initial procedure.
Chelmsford Foot Clinic would like your help and support in gathering more evidence of this procedure so if you are considering this treatment and would like to take part in a clinical trial, then please contact Gillian May at Chelmsford Foot Clinic, and be part of something special.