Plantar warts are one of the most challenging infections to treat as a podiatrist. I often joke that warts are like unwanted house guests that leave when they want to leave. The virus is happy living in the outer layers of your skin undetected by your immune system. If you pick at them, they can spread and become very large and painful.
There are many treatment options; acid, duct tape, and liquid nitrogen, because no one treatment works for everyone. Topical acids and cryotherapy (freezing warts) do not work well on the plantar skin because it is the thickest skin on the body. Often podiatrists start with cantherone, "beetle juice". This medication works by creating a contact dermatitis, a skin allergy causing the skin to blister kicking the wart out with the blister. There is no pain when the doctor applies the medication but the blister that develops 2-3 days later can be very painful. Another problem with cantherone is we have no idea how the patient is going to react. The patient may have a huge blister or no blister after the first application. It may take several treatments for the wart to go away and there is no guarantee it will resolve.
Patients often ask, "Can you just cut it out?" Excising a plantar wart if it is a small single solitary lesion is effective but there are downsides and risks. The area needs to be numbed up and involves an injection with a local anesthetic which is very painful. Removing the wart creates a wound that takes 2-3 weeks to heal. Daily dressing changes are required following the procedure to reduce the risk of infection. Patients are advised not to run, walk, or swim for exercise while the wound is healing. If every bit of the virus is not removed during the procedure the wart may come back.
I personally do not recommend excising warts. It is painful and traumatic for the patient. There are newer treatments for warts that are more effective and have less downtime. We have recently incorporated Swift microwave therapy into the practice. I like Swift because there are no chemicals, no wounds, and no home care. Swift works by using microwave energy applied directly to the wart for 2 seconds in several areas. The microwave energy targets and heats the water molecules within the wart. This reaction uncloaks the proteins of the virus and exposes them to your immune system. The patient's immune system sees the wart and starts fighting it. The wart gradually fades away. No blisters, no wounds, no dressings. The downside to Swift is that there is a quick jolt of pain during the treatment, like a bee sting. Most folks tolerate it well and the pain resolves instantly after the treatment.
At Lighthouse Foot and Ankle we want to help. If you would like to find out more, visit our website or call us at (207) 774-0028 to schedule your next appointment.
