Wart (verruca)

Wart (verruca) 

By Gabrielle Lee-Kim, DPM, AACFAS

Wart (verruca) is one of the most common pedal problems in both adult and pediatric population.


It is caused by the human papillomavirus (HPV) and it is highly contagious. Most of the time people get warts on the feet when they walk barefoot in public shower, pool, step on the surface where a person with the wart has stepped on, or with shared towels/washcloths. The most common body part is bottom of the foot through breaks in the skin and it is called “plantar wart”. In the summer, people get it in the shower or the pool and in the winter they get it through rough fissures on the bottom of the foot. So, it is important to take care of your feet all year long in order to prevent this viral infection. 

Verruca classically presents with pinpoint bleeding with black dots and pain with squeezing. It can spontaneously resolve if it bleeds out when the surface is taken off. However, majority of the time it requires serial debridement and medications. If wart is not taken care of immediately and builds up, it can show cauliflower appearance and can be quite painful. 
Wart can be treated with multiple debridements and salicylic acid treatment that patient is instructed to apply daily. Second option is topical cantharidin application which is done by the physician and patient is instructed to wash with soap and water in 6 hours. If patient does not follow the instructions the area can ulcerate so it is paramount for the patient to follow the instructions closely. It usually causes the area to blister up in a few days which grabs the wart when it naturally comes off. Wart can also be treated with cryotherapy (freezing) which is done in the office and it usually requires multiple (6-7 sessions) treatments to completely resolve it. Electrosurgery with hyfrecation can also be done by the physician in the office.  The foot requires anesthetics before this procedure so it is patient’s preferences if the patient can tolerate the injection. After the foot is anesthetized, electrosurgery and subsequent mechanical debridement is performed until patient’s anatomic skin line is visible. If above conservative treatments fail, patient can undergo surgical intervention for the verruca excision in the operating room. 
As verruca is highly contagious, it is crucial to seek medical attention in a timely manner in order to prevent spreading. Patients are also instructed to disinfect the bathtub and all of their shoes in order to prevent recurrence. Routine foot check ups every 6-8 weeks can prevent this type of infection or catch infections early if it already happened. 

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