Plantar wart is a hard and flat formation on the skin of the foot, slightly rising above its level and covered with a layer of keratinized epithelium. The main method of diagnosing plantar warts is dermatoscopy. The location of the wart on the sole leads to its permanent injury and soreness during walking. For this reason, a plantar wart often requires treatment, although it can go away on its own. Methods of removal include cryotherapy, electrocoagulation, removal by radio wave apparatus or laser.
General information
Plantar wart refers to benign skin neoplasms and accounts for approximately 34% of all warts. Dermatology deals with the diagnosis and treatment of warts. The use of folk methods of getting rid of warts and self-medication is highly undesirable. The plantar wart has a root that goes deep into the skin and its incomplete removal will lead to a new growth of the wart, and excessive damage to the surrounding tissues will lead to the appearance of warts on other parts of the body.
Causes
Papillomas and all types of warts (ordinary, flat, filiform, plantar) have the same nature — infection of the body with the papilloma virus (HPV). The virus spreads among people through infected skin cells (by contact). The most favorable for it is a humid and warm environment. Therefore, HPV infection often occurs in swimming pools, saunas, baths and gyms. With a sufficiently strong immune system, HPV in the human body remains in a latent state and does not give clinical manifestations. A malfunction in the immune system leads to the activation of the virus and the appearance of the above formations on the skin.
Excessive sweating (hyperhidrosis) or dryness of the skin of the feet can contribute to the development of plantar warts; uncomfortable shoes that cause compression or friction of the skin of the foot; various deformities of the foot (flat feet, deforming osteoarthritis, arthritis of small joints of the foot); diseases that lead to a violation of the trophic tissues of the foot (diabetes mellitus, varicose veins of the lower extremities, atherosclerosis, etc.), damage to the skin of the foot.
Symptoms
The plantar wart is a hard, clearly delineated seal on the sole. Most often it has an oval or rounded shape and a size of about 1-2 cm. The formation protrudes 1-3 mm above the general level of the skin. The skin color in the plantar wart area is usually not changed, but it can be light brown or pink.
The surface of the wart at the beginning of its formation is smooth. Over time, it becomes covered with layers of keratinized epidermis, becomes rough and acquires a gray-yellow hue. Sometimes there is a crater-like depression in the center of the plantar wart. Black-brown dots, which can often be seen on the surface of the wart, are caused by thrombosis of the surface capillaries.
As a rule, the plantar wart is of a single character. The appearance of daughter warts indicates a high activity of the virus. Multiple warts give a mosaic pattern to the affected area of the sole, for which they were called “mosaic warts”.
There may be an independent disappearance of the plantar wart. In this case, no trace remains on the skin of the foot. But more often, due to constant injury, self-resolution of the wart does not occur. Not painful in itself, it begins to cause the patient considerable discomfort and even sharp pain associated with the friction and pressure of the wart on the sole of the shoe.
Diagnostics
In its appearance, a plantar wart often resembles a corn or a site of cutaneous hyperkeratosis. Only a professional dermatologist can distinguish it from these formations. To do this, a dermatoscopy is performed. In order to better investigate the formation, the doctor pre-scrapes the upper layers of the keratinized epithelium. The absence of a skin pattern on the surface of the formation and the identification of a characteristic symptom of “thrombosed capillaries” speak in favor of a plantar wart. Positive results of PCR diagnostics for HPV confirm the infection of the patient.
To determine the depth of germination of the plantar wart, the patient is assigned an ultrasound of the skin formation. If a malignant nature of the formation is suspected, a dermatooncologist is consulted. If deformities and diseases of the foot are detected, a podiatrist’s consultation is necessary.
Plantar wart is differentiated with keratodermia of the soles and palms in Reiter’s syndrome. The smaller size of the formation, not a conical, but a flat shape, the symptom of “thrombosed capillaries” and the absence of inflammatory changes around the keratinized layers make it possible to distinguish a plantar wart from keratodermia. Palmar-plantar syphiloids have some similarities with plantar warts. They are distinguished from the latter by their multiple nature, painlessness and characteristic arrangement in the form of rings or arcs, a positive RPR test for syphilis.
Plantar wart treatment
Removal of the plantar wart is complicated by its deeper germination into the dermis, compared with other types of warts. For this reason, electrocoagulation, for example, is not always suitable for getting rid of a wart. Its use is possible only in the case of a shallow location of the plantar wart and is often complicated by the formation of a scar.
Cryodestruction of the wart gives good results. Its result depends on the experience of the doctor, since too deep an impact can lead to wound healing with scar formation, and too superficial — to a recurrence of the wart. After treatment with liquid nitrogen, a blister remains in place of the wart, which cannot be injured until it heals (about 7 days). Laser removal gives the best cosmetic result and allows you to adjust the depth of exposure in the most optimal way. Laser removal of warts is quick and painless, and healing takes several days.
To remove a plantar wart, a radio wave method can also be used, in which the wart is cut out with a radio knife. At the same time, the vessels are cauterized, which prevents bleeding and the virus from entering the blood from the wart. Surgical excision is suitable for large plantar warts. It is carried out with a conventional scalpel under local anesthesia and can be complicated by scar formation.
Prevention
The primary prevention of the appearance of plantar warts is to prevent HPV infection. Particular attention should be paid to the mandatory wearing of individual shoes in public showers, swimming pools and baths. Of no small importance, especially for people with foot diseases, is proper foot skin care: regular pedicure, foot peeling and their treatment with softening agents.
Patients with deformity of the feet need to use orthopedic insoles, orthoses, unloading correctors. With increased sweating of the feet, it is important to choose shoes made of natural materials and use drying agents. With dryness and cracks on the skin of the soles, nourishing and moisturizing creams, therapeutic foot baths are necessary.
Secondary prevention of plantar warts consists in prescribing antiviral drugs and immunocorrectors to the patient along with the removal of the wart.