Verrucae

Verruca / Plantar Wart

A verruca is simply a wart that is usually found on the soles of feet or around the toes.  It may start off as a small white dot but may later develop a black spot in the middle, which is caused by bleeding in the centre. It may become rough and bumpy with a cauliflower-like appearance and can grow to half an inch in diameter and may spread into a cluster of smaller warts.

Verrucae are caused by the human papiloma virus (HPV). This virus is contagious. It thrives in warm, moist environments such as swimming pools, changing room floors and bathrooms. So 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.

These generally harmless lesions usually spontaneously resolve in 2-5 years (NHS, June 2014). However they can cause a sharp, burning pain if you get one on a weight-bearing area such as the ball or the heel of the foot. Because you are constantly pressing on the area when walking, they can protrude into the skin and become more painful.

Who gets them?

Then tend to be common in children, especially teenagers. However, for unknown reasons, some people seem to be more susceptible to the virus, whereas others are immune.

Studies have shown in healthy children up to the age of 16, over 90% of verrucae resolve without the need for treatment and 70% of children will have a verruca at one time or another (NHS, June 2014). But in adults, they can persist for years. Aggressive treatment can irritate delicate skin and be painful and leave scarring.

What can I do?

Minimise your chances of catching a verruca by keeping your feet clean and dry, and covering any cuts or scratches. Avoid walking barefoot in communal showers or changing rooms (wear flip-flops) and don’t share towels. Verruca socks should be worn when swimming to avoid passing on the virus to others. If a verruca does appear, avoid touching or scratching it as it may spread into a cluster of several warts. Instead, cover it up with plaster. Do not self-treat if you have diabetes or circulation problems.

However, if you are fit and healthy, it’s fine to treat yourself with over-the-counter gels and ointments. Ask your pharmacist for advice or look for products containing salicyclic acid, such as Verrugon, Bazuka, or Occlusal, and ensure that you follow the instructions carefully. Try to avoid damaging the surrounding healthy skin.

What can a podiatrist do?

Because verrucae usually often disappear in time (fought off by your immune system), the general policy in the UK is to only treat them when they are causing pain. If yours is painful, there are a number of treatment options available – though no one treatment can guarantee a cure. Other treatments include:

Homeopathic – There are a range of alternative and homeopathic treatments available, however none of these have had their efficacy proven with research.

*Salicylic Acid – a stronger acid than you are able to buy over the counter can be applied in the clinic. The treated area will need to be kept dry for 48 hours after application. Treatment is usually needed on a weekly basis.

Cryotherapy – This involves freezing warts off with liquid nitrogen or nitrous oxide gas. This needs to be done every 1 or 2 weeks for a few months before the verruca is fully resolved. However, it can lead to soreness and blistering in some people. You can still swim after this treatment, but it’s not advised for sensitive or anxious children.

Electrosurgery – After a local anaesthetic, the verruca is pared down. The verruca is then removed with an electrode. Weight must not be bared on the foot for at least 48 hours.

*Laser therapy – non-invasive, using application of infra-red light to stimulate the body’s own immune system, a course of weekly treatments are necessary.

*Dry needling – after a local anaesthetic at the ankle, the verruca is repeatedly irritated with a needle to stimulate the immune system.

Imiquimod – this is a prescription only cream which your GP can give you. Applied three times a week for a couple of months, it helps to stimulate the immune system.

In short, you can treat your verruca with an over-the-counter medicine unless you have diabetes or circulation problems. If the verruca appears to be getting bigger or is painful, consult a podiatrist.

*Available at the clinic