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ARROYO FOOT & ANKLE CLINIC

Warts

Description

Warts are lesions that can arise on any skin surface. On the feet, the usual sites for warts are on the bottoms of the feet and on the toes. The word 'plantar' designates the bottom of the foot, so a wart found in that location is called a 'plantar wart'. Warts occur in all age groups, but are more prevalent in children and teen-agers.

 You may first notice a wart as a small, white, beige or gray lump in the skin, which can be quite tender when you walk. Close inspection reveals a sometimes rough, cauliflower-like texture to the skin (this can be variable; at time, the texture can be smooth, with slightly raised edges). Normal skin lines are interrupted. There may be flecks of dark color (red, black, purple or brown) within the lesion. Often, there is a thin ring of callus tissue at the margin of the lesion. Depending on location and type, a wart may project out from the skin, or may be on about the same level as the surrounding skin. Warts tend to be tender if you press on them directly, and even more tender if you squeeze them from the sides.

Initially, warts are solitary lesions. With time, the first (mother) lesion gives rise to multiple, at first smaller, daughter lesions. These can progress to enlarge and coalesce. Given time, warts can exceed two inches in diameter.

Warts are an infection by the human papilloma virus. The virus usually gains entrance to the skin through a small puncture wound, such as that sustained when stepping on a goathead thorn, or by a cut or abrasion. Handling frogs or toads, of course, has nothing to do with this process. The virus lives at the junction of the two main layers of the skin, the dermis and the epidermis, within the cells. Here, the virus can be in a dormant, inactive phase, or in an active phase. When the virus is inactive, there are no skin changes to indicate its presence. When active, the virus forces the changes in skin architecture described above.

Warts can resolve on their own within a couple of years, but may later return to the same site. In other cases, warts may persist for many years.

Diagnosis

Warts can almost always be identified by clinical examination. Since there are other, more serious lesions that can be mistakenly identified as warts, such as carcinomas and melanomas, professional consultation is strongly advisable. In questionable cases, after being excised, a suspected wart may require being sent to a pathology lab for final diagnosis.

Treatment

There are numerous treatments available for warts. The treatment recommended by your physician is determined by where on your feet the warts are located, their size and number, and how long you've had the warts. Any prior treatments used and their success, as well as your general health status, will also inform your doctor's decision.

Cryosurgery, freezing the wart with liquid nitrogen or other substances, is an effective treatment for most warts. Electrocautery, burning out the wart with an electric probe is an alternative treatment. Your doctor may recommend laser excision of your wart, if it's a larger or more resistant type. Surgical excision or chemicals applied to the skin can be used. In cases that prove more resistant, or in which the numbers of warts are extensive, injected or oralmedications may be called for.

 No matter which treatment method is advised in your case, several treatments are frequently required in ridding your body of this infection.

It is not advisable to use over-the-counter preparations on warts found on the foot. They are usually ineffective, and can easily injure normal skin along with the wart. These preparations are especially dangerous to people with diabetes, decreased circulation, or those people who are immune-compromised, such as those on long-term steroid therapy, or those with AIDS.

What you can do

Warts are an infection and are contagious. They are spread by being manipulated. If they bleed, which they can easily do if they're scratched, the infection can be spread in the blood.

  • Refrain from manipulating warts.
  • Do not go bare-footed, even in the house.
  • Keep your feet clean and dry.
  • Examine your feet at least once a week. Warts tend to respond to treatment more readily when treatment is began early.
  • Avoid direct contact with warts, either with non-infected parts of your body on your warts, or warts on other people.
  • If you suspect you have a wart, contact your podiatrist promptly for treatment.
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