Verrucae Pedis

What are they?
Verruca is the Latin term for ‘Plantar Wart’. Simply a lump of hard skin which DOES NOT grow inwards but is “flattened” by the action of walking.
How are they spread?
The verruca is caused by a virus infecting the skin. It is not understood exactly how they are spread. In the past it was argued that, there was more chance of getting a verruca where barefoot activities are taking place (however this has never been scientifically proven). This DOES NOT mean that everyone going swimming will eventually get a verruca, and thankfully many pools have put signs up stating that it is acceptable to enter the pool even if you have a verruca. This will help remove some common myths surrounding the verruca.
Treatment
Most verruca are NOT painful, and if left alone will eventually disappear. There is plenty of evidence to show that, once they have cleared ‘naturally’ an increased immunity to

further infection is conferred. Those which are painful, often are only so due to being “messed with”, or being pinched by footwear. If it is felt the discomfort is too much to bear, or the verruca is taking much too long to disappear naturally, it can be treated effectively by a chiropodist.
Commonly treatments usually involve the use of chemicals, and/or machines to freeze or burn the part. Although the method used will be adapted by all practitioners to be as kind and quick as is possible, removing a verruca is often lengthy, expensive, and painful. HOME TREATMENT is dangerous and inadvisable. Most verrucae that I have actually had to treat, had been damaged by some product sold over a chemist counter (a situation that has got worse since the mid 1990’s when the restrictions on television advertising of these weak toxins were lifted).
What does one usually look and feel like?
A slightly raised hard round yellow lump with a crusty white middle containing black dots. If pressed upon no discomfort is felt, but it is very painful if pinched. Usually there is only one or two ‘blobs’ and most people are unaware of them until pointed out. They can be more sensitive first thing in the morning, when hot, and after exercise, when a sharp twinge is noticed as the heart pounds. Sometimes a few centimetres of skin is affected by a different verruca virus causing a ‘Mosaic Wart’, this type is particularly resistant to treatments.
Private Swimming Pools, and Children
Sometimes owners of premises outside state control insist that “verruca socks” are worn. Whilst there is no evidence these work, they can alley the prejudice of others. (Care should be taken as they can cause slipping - if only one foot is affected only wear one sock).

Reasons For Treatment.

Usually the reason a Chiropodist will agree to treat a verruca is:
1) The verruca has been “messed with” already, either by the application of ‘wart cures’ in the home, or unqualified practitioners having damaged the skin, and it is felt the bodies defences consequently have been compromised.
2) Social pressures upsetting the patient, commonly in the form of victimisation, often hearsay & the prejudice of other people stops the person following a ‘normal’ lifestyle, i.e. believing they are prevented from swimming.
3) If the verruca is on a part of the foot that means it regularly gets pinched, and the discomfort is constant.
4) Systemic medical problems that mean the patient is unable to deal with this minor infection naturally.
5) The infection appears to be seriously spreading (although this is usually due to one or more of the reasons above).

IDEALLY LEAVE THE VERRUCA ALONE! THIS CANNOT BE EMPHASISED ENOUGH
However if a more radical method actually is requested, there are several factors to be taken into consideration:
a) How quickly the verruca needs to be cleared up. b) The medical history and current health of the patient. c) Whether a scar left afterwards would be a problem. d) If previous treatment attempts prevent hope of success now. e) How sensitive is - the patient/that part of the foot. f) Cost.
Inescapable Consequences of Treatment
If you are trying to kill a bit of skin containing a verruca it will hurt! Our skin is full of nerves which will be extra sensitive, especially if the part is or has been cut away or damaged by a chemical.
The only trade off we can do is cause a little pain over several weeks, or cause a great deal of pain for a day or two. Analgesics, and anaesthetics may only be helpful in reducing suffering.
There is no treatment guaranteed to work, and having a verruca treated once unsuccessfully makes it considerably more difficult to get any other method to work in the future, so if treatment must be done choosing the right one first time is critically important.
Very Common Treatment Procedures in the UK
Cryotherapy The verruca is frozen twice, a pad made to keep the pressure off afterwards. (I sometimes will still offer this old-fashioned treatment when clinically indicated). Each treatment is finished the day you come, but may need repeating not sooner than 6 weeks again.
Strong Acid Based Ointments Put inside a pad onto the verruca, kept in place and dry for one or more weeks, when you return to the surgery I remove the pad and wart or repeat the treatment. Pain at home during this treatment is often much relieved by elevating the part and taking an analgesic, but rarely is there discomfort in the surgery. This commonly used method always requires you return to the practice on the appointment day booked. Often it will take two to six weeks of treatments to work.
Liquid Caustics Applied to the verruca directly. This is an accurate but lengthy, therefore expensive, treatment. It is usually painful during applications at the surgery, but less of a problem at home and work. It can easily take several months of applications twice a week.
Surgical and Electrical Sometimes an ideal treatment for adults, although it does require a local anaesthetic, and can leave scar’s.
Home (Bought from Chemist) Acid Treatments Every patient I have seen try these has had no success, found they caused harm, or if the wart went, success is easily attributed to the body having cured itself (which happens all of the time and almost always it would be better to let the body cure these themselves anyway).
Less Common Treatment Procedures in the UK
Herbal Remedies A simple application of a concentrated plant extract after removal of the overlying hard skin can be an ideal treatment especially for a very nervous patient, or someone who does not mind waiting a little longer for a resolution.
Immune Response Triggering This procedure I seem to be using more and more, it does involve a little discomfort in the surgery but has such clear benefits above most other treatments that often make it a first choice where a professional intervention is indicated.

SUMMARY:
I hope you have not been frightened by this leaflet, but I aim to answer most questions people are reluctant to ask. The trends have changed over the years, in 1979 I treated over half of the patients seen with verrucae, from 1993 until 2004 I treated on average just two verrucae each year, so the prejudice making people want to treat them has been slowly disappearing against them. By 2011 (when I last updated this page) I appear to be treating about one in eight verrucae that I see, most often using an "Immune Response Trigger" method rather than any other choice. Seven out of eight people I see choose to let the verrucae eventually go themselves untreated.

KNOWN FACT - 75% of all verrucae clear themselves in under 2 years.
KNOWN FACT - 33% of warts tested also had the virus in tissue 5-10cm away from the hard skin lump (coincidentally KNOWN FACT - 33% of all independent researched “successful” treatments had new regrowths 1 year later).

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