Introduction
Background
Plantar warts are hyperkeratotic lesions on the plantar surface. They tend to develop over areas of pressure such as the heel and ball of the foot. Plantar warts are often endophytic (ie, they grow into the deeper layers of skin because of pressure). Although they are generally self-limited, plantar warts should be treated to lessen symptomatology, decrease duration, and reduce transmission.
Pathophysiology
Human papillomavirus (HPV), usually of type 1, 2, or 4, causes plantar warts. HPV attacks the epidermal layers through direct contact. See Human Papillomavirus.
Frequency
United States
Plantar warts are widespread; 7-10% of the population have warts.
Mortality/Morbidity
- Plantar warts may cause pain, particularly when walking.
- They may spread to other sites but not to histologically dissimilar areas (ie, plantar warts do not spread to genitalia).
- Most resolve spontaneously.
Sex
Plantar warts affect females slightly more often than males.
Age
Plantar warts may occur at any age, although they are more common in children and teenagers.
Clinical
History
- Foot pain
- Leg or back pain (secondary to distortion or posture)
Physical
- Firm, hyperkeratotic lesions with tiny pinpoint petechiae centrally
- Smooth surface with a gray-yellow color
- Usually occur over areas of pressure or bony prominence such as the heel and ball of the foot
- Usually flat because of pressure
- Several warts may fuse to form mosaic warts
- Often difficult to differentiate warts from nonviral causes such as keratoses, lichen planus, molluscum contagiosum, corns, calluses, and foreign body or stress fractures
- Hyperkeratotic tissue reveals typical punctate hemorrhages, which represent thrombosed capillaries of the papilloma.
- Pathologic findings include acanthotic epidermis with hyperkeratosis.
- Papillomatosis
- Parakeratosis
Causes
Plantar warts are caused by direct exposure of HPV to the epidermis. This occurs through breaks in the stratum corneum of the epidermis. Such exposure frequently is associated with using public showers.1
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References
Johnson LW. Communal showers and the risk of plantar warts. J Fam Pract. Feb 1995;40(2):136-8. [Medline].
Al-Gurairi FT, Al-Waiz M, Sharquie KE. Oral zinc sulphate in the treatment of recalcitrant viral warts: randomized placebo-controlled clinical trial. Br J Dermatol. Mar 2002;146(3):423-31. [Medline].
Skinner RB. Imiquimod. Dermatol Clin. Apr 2003;21(2):291-300. [Medline].
Allam JP, Hagemann T, Bieber T, Novak N. Successful treatment of therapy-resistant plantar verrucae vulgares with systemic interferon-beta. J Dermatol. Jul 2004;31(7):582-3. [Medline].
Esterowitz D, Greer KE, Cooper PH, Edlich RF. Plantar warts in the athlete. Am J Emerg Med. Jul 1995;13(4):441-3. [Medline].
Landsman MJ, Mancuso JE, Abramow SP. Diagnosis, pathophysiology, and treatment of plantar verruca. Clin Podiatr Med Surg. Jan 1996;13(1):55-71. [Medline].
Nelson WE, Behrman RE, Kliegman RM. Nelson Textbook of Pediatrics. 15th ed. WB Saunders Co; 1995:1901-1903.
Nelson WE, Behrman RE, Kliegman RM. Nelson Textbook of Pediatrics. 14th ed. WB Saunders Co; 1992:1901-1903.
Schroeter CA, Pleunis J, van Nispen tot Pannerden C,Reineke T, Neumann HA. Photodynamic therapy: new treatment for therapy-resistant plantar warts. Dermatol Surg. Jan 2005;31(1):71-5. [Medline].
Further Reading
Keywords
verruca plantaris, human papillomavirus, HPV, hyperkeratotic lesions, heel, ball of the foot, mosaic warts, acanthotic epidermis, papillomatosis, parakeratosis, public showers, keratoses, lichen planus, molluscum contagiosum, corns, calluses, black heel, keratinolytic medications, cryotherapy, imiquimod
