Plantar Warts



Patient Story





A 15-year-old boy presents with painful growths on his right heel for approximately 6 months (Figure 134-1). It is painful to walk on and he would like it treated. He was diagnosed with multiple large plantar warts called mosaic warts. The lesions were treated with gentle paring with a #15 blade scalpel and liquid nitrogen therapy over a number of sessions. He and his mom were instructed on how to use salicylic acid plasters on the remaining warts.







Figure 134-1



Plantar warts. Note small black dots in the warts that represent thrombosed vessels. Large plantar warts such as these are called mosaic warts. (Courtesy of Richard P. Usatine, MD.)







Introduction





Plantar warts (verruca plantaris) are human papilloma virus (HPV) lesions that occur on the soles of the feet (Figures 134-1, 134-2, 134-3, 134-4, and 134-5) and palms of the hands (Figure 134-6).







Figure 134-2



Close-up of plantar wart on the side of the heel. Note the disruption of skin lines and black dots. (Courtesy of Richard P. Usatine, MD.)








Figure 134-3



Close-up of a plantar wart demonstrating disruption of normal skin lines. Corns and callus do not disrupt normal skin lines. The black dots are thrombosed vessels, which are frequently seen in plantar warts. (Courtesy of Richard P. Usatine, MD.)








Figure 134-4



A mosaic wart is formed when several plantar warts become confluent. (Courtesy of Richard P. Usatine, MD.)








Figure 134-5



Multiple plantar warts on the ball of the foot and toes. The thrombosed vessels within the warts appear as black dots. (Courtesy of Richard P. Usatine, MD.)








Figure 134-6



Multiple plantar warts on the palms of an HIV-positive man. (Courtesy of Richard P. Usatine, MD.)







Synonyms





Palmoplantar warts, myrmecia.






Epidemiology






  • Plantar warts affect mostly adolescents and young adults, affecting up to 10% of people in these age groups.1
  • Prevalence studies demonstrate a wide range of values, from 0.84% in the United States2 to 3.3% to 4.7% in the United Kingdom,3 to 24% in 16- to 18-year-olds in Australia.4






Etiology and Pathophysiology






  • Plantar warts are caused by HPV.
  • They usually occur at points of maximum pressure, such as on the heels (Figures 134-1, 134-2, 134-3, and 134-4) or over the heads of the metatarsal bones (Figure 134-5), but may appear anywhere on the plantar surface including the tips of the fingers (Figure 134-7).
  • A thick, painful callus forms in response to the pressure that is induced as the size of the lesion increases. Even a minor wart can cause a lot of pain.
  • A cluster of many warts that appear to fuse is referred to as a mosaic wart (Figures 134-1 and 134-4).







Figure 134-7



Close up of plantar wart on a finger that also shows disruption of skin lines and black dots. (Courtesy of Richard P. Usatine, MD.)




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Jun 5, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Plantar Warts

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