Austin Foot & Ankle | Ingrown/Fungal Toenails and Warts

Papilloma, Verruca Plantaris

What's the problem?

How does it feel?
A plantar wart feels like a lump under the foot. They are only painful is they are squeezed or pinched from side to side, or if you bear direct weight on them. Warts on other parts of the body, such as the hands, grow elevated above the skin's surface. We bear weight on warts on the bottom of the foot, so they get flattened and pushed into the skin. Most people liken this to walking with a rock attached to the foot, as the thickened callous tissue becomes hard and painful as it gets bigger.

Let's do a test
A plantar wart can usually be diagnosed by your doctor based on a characteristic appearance alone. When the doctor trims the hard callus tissue from the surface of the wart, a pattern of small black dots that are actually small blood vessels that feed the wart, is usually seen. The doctor will also test the wart by pressing directly down on it, and then pinching it, squeezing it from side to side. Most warts won't hurt when pressed directly down, but are very painful when pinched. If these findings are present, no further testing is necessary to identify a plantar wart.

How did this happen?
All warts are caused by the Papilloma virus, a slow growing virus which invades the skin. The viruses are common in all of our environments and they don't readily grow on intact skin. But if there is a break in the skin, like a scratch or thorn penetration, this gives the virus the opportunity to get in and start growing. The virus only grows in the epidermis, the thick layer of the skin closest to the surface. It doesn't invade the dermis, the deeper layer of the skin. However, the epidermis and the dermis are closely entwined, and the dermis under the wart grows extra blood vessels and nerves in response to the virus infected cells above it in the epidermis. It is because of these nerves that the wart hurts when pinched and because of these blood vessels that it stays well nourished enough to grow. The virus particles can spread from the main wart, along the cutaneous (skin) nerves, to begin growing remote or satellite warts at a distance from the original site. If enough of this spread occurs, mosaic warts result.

What can I do for it?
Over the counter products that contain the ingredient salicylic acid may be tried if you have good blood flow, good feeling in your feet, and the wart is small. However, their use is slow and frustrating. They are acids which slowing destroy the wart from the surface down. Diabetics or other people with numbness or bad circulation should not use these products, as it can be dangerous for them. You may also try treating the wart by keeping it covered with tape at all times. This seems to prevent the wart from growing as rapidly and may be of some benefit when combined with other treatment. The thick callus tissue can be carefully removed with a pumice stone or file. This must be done in between applications of the salicylic acid medicine.

What will my Doctor do for it?
Your doctor has a number of choices for treating your Plantar Wart. Unfortunately, warts are stubborn entities and even the best methods for removing them allow a high rate of reoccurrence, around 15%.

He may choose to use medication that is stronger than what is available at the pharmacy. This can speed up the process. Depending on the size and number of warts, treatment can take from 1-4 months before the wart is completely gone, and like any infection, all parts of it must be completely eliminated, or it will grow back.

Your doctor may choose to use an oral medicine called Tagamet (Cimetadine) or an ointment called Efudex (5-fluorouracil) on the wart. Intralesion injections of Bleomycin may be used to treat the wart from the inside out.

An additional option is to physically remove the wart at one time, either surgically, with a spoon like instrument called a curette, or with the CO2 laser. The healing time is from 2-4 weeks, depending on the size. Use of the CO2 laser reduces the rate of reoccurrence to 10%, reduces post-operative pain and eliminates any bleeding.

Can I prevent this from happening again?
Keep your feet clean and dry. Inspect feet frequently for new warts and begin treating small ones immediately, before they increase in size or number.

Ingrown/Fungal Toenails, Warts, Skin Tags

Plantar Warts

Papilloma, Verruca Plantaris



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If an infection has developed, the doctor may send a sample of the drainage to a lab, to identify what bacteria has caused the infection and which antibiotics will most easily cure the infection. How did this happen? A progression of events occurs. Routinely cutting the nails improperly, down at an angle instead of straight across, is the most common cause of Ingrown Nails. Wearing narrow or pointed shoes can apply enough pressure to a normal nail to turn the nail edge downward. Once the nail matrix, the tissue where the nail grows from, gets injured in this way, it continues to produce a nail edge that is more vertical than horizontal. From this abnormal nail growth, the nail edge applies mild pressure on the skin over a long period of time. The skin at the nail edge thickens and becomes hardened. You may begin to notice an enlargement or swelling of the skin around the nail edge. This can be accompanied by an increase in pain. The condition can progress as a result of other factors. These factors include: pressure from a tight or pointed shoe, injury such as stubbing a toe, excessive wetness, either from perspiration or application of ointments or creams, or improper cutting of nails If these factors come into play, the possibility increases that the nail edge can then penetrate the skin, just like a knife, and cause an infection. The skin at the nail edge becomes reddened and swollen. You may notice drainage or pus from the area and the pain becomes intolerable. What can I do for this? In mild cases, where no infection is present, pain relief can be obtained by applying a standard moisturizing cream to the nail edge and covering with a bandaid. This softens the hard skin and often provides temporary pain relief. In more advanced cases, where redness or obvious infection is present, seek the attention of a doctor. What will my Doctor do for this? In the most minor cases, the podiatrist will simply cut the nail to shorten it, and show you how to cut the nail in the future, to prevent ingrowing of the nail again (See below for instructions on proper nail cutting). In more severe cases, but not those in which an infection hasn't developed, the podiatrist may gently remove the ingrown portion of the nail. This affords considerable relief, but is temporary. After a few weeks, when the nail grows long again, it will again grow in. In cases where the nail has grown in repeatedly, or more critically, when the nail edge has penetrated the skin and caused an infection, the podiatrist will perform a minor procedure called an Ingrown Nail Correction or Matricectomy. The podiatrist will gently numb your toe, reshape the nail edge and finally, apply a medicine which will, in most cases, permanently prevent the nail edge from growing improperly again. Can I prevent it from happening again? Cutting toe nails properly goes a long way toward the prevention of ingrown nails. Use a safety nail clipper, available at every drug store on the planet. Cut the nails STRAIGHT ACROSS, so that the nail corner is visible. If you cut the nail too short so that the nail corner is not visible, you are inviting the nail corner to grow into the skin. It is the natural tendency, when the edge of the nail starts to grow in, to cut down at an angle at the nail edge, to relieve the pain. This DOES relieve he pain TEMPORARILY, but it also starts the downward spiral, training the nail to become more and more ingrown. What happens is that cutting down at an angle creates a space at the nail edge. When the advancing nail edge reaches the space, it rolls downward, taking the course of least resistance. The edge becomes more and more ingrown, until it pierces the skin and makes an infection. So, cut the nails STRAIGHT ACROSS and prevent having an ingrown nail again. Plantar Warts Papilloma, Verruca Plantaris What's the problem? A plantar wart is a small skin lesion that resembles a callus and is found on the bottom of the foot or toes. The term "plantar" doesn't mean only farmers get them. "Plantar" means they occur on the bottom surface of the foot. It is usually under 1 cm diameter, but can occur in clusters and be much larger. Sometimes a single larger wart is surrounded by many smaller warts. In this case, they are called mosaic warts. How does it feel? A plantar wart feels like a lump under the foot. They are only painful is they are squeezed or pinched from side to side, or if you bear direct weight on them. Warts on other parts of the body, such as the hands, grow elevated above the skin's surface. We bear weight on warts on the bottom of the foot, so they get flattened and pushed into the skin. Most people liken this to walking with a rock attached to the foot, as the thickened callous tissue becomes hard and painful as it gets bigger. Let's do a test A plantar wart can usually be diagnosed by your doctor based on a characteristic appearance alone. When the doctor trims the hard callus tissue from the surface of the wart, a pattern of small black dots that are actually small blood vessels that feed the wart, is usually seen. The doctor will also test the wart by pressing directly down on it, and then pinching it, squeezing it from side to side. Most warts won't hurt when pressed directly down, but are very painful when pinched. If these findings are present, no further testing is necessary to identify a plantar wart. How did this happen? All warts are caused by the Papilloma virus, a slow growing virus which invades the skin. The viruses are common in all of our environments and they don't readily grow on intact skin. But if there is a break in the skin, like a scratch or thorn penetration, this gives the virus the opportunity to get in and start growing. The virus only grows in the epidermis, the thick layer of the skin closest to the surface. It doesn't invade the dermis, the deeper layer of the skin. However, the epidermis and the dermis are closely entwined, and the dermis under the wart grows extra blood vessels and nerves in response to the virus infected cells above it in the epidermis. It is because of these nerves that the wart hurts when pinched and because of these blood vessels that it stays well nourished enough to grow. The virus particles can spread from the main wart, along the cutaneous (skin) nerves, to begin growing remote or satellite warts at a distance from the original site. If enough of this spread occurs, mosaic warts result. What can I do for it? Over the counter products that contain the ingredient salicylic acid may be tried if you have good blood flow, good feeling in your feet, and the wart is small. However, their use is slow and frustrating. They are acids which slowing destroy the wart from the surface down. Diabetics or other people with numbness or bad circulation should not use these products, as it can be dangerous for them. You may also try treating the wart by keeping it covered with tape at all times. This seems to prevent the wart from growing as rapidly and may be of some benefit when combined with other treatment. The thick callus tissue can be carefully removed with a pumice stone or file. This must be done in between applications of the salicylic acid medicine. What will my Doctor do for it? Your doctor has a number of choices for treating your Plantar Wart. Unfortunately, warts are stubborn entities and even the best methods for removing them allow a high rate of reoccurrence, around 15%. He may choose to use medication that is stronger than what is available at the pharmacy. This can speed up the process. Depending on the size and number of warts, treatment can take from 1-4 months before the wart is completely gone, and like any infection, all parts of it must be completely eliminated, or it will grow back. Your doctor may choose to use an oral medicine called Tagamet (Cimetadine) or an ointment called Efudex (5-fluorouracil) on the wart. Intralesion injections of Bleomycin may be used to treat the wart from the inside out. An additional option is to physically remove the wart at one time, either surgically, with a spoon like instrument called a curette, or with the CO2 laser. The healing time is from 2-4 weeks, depending on the size. Use of the CO2 laser reduces the rate of reoccurrence to 10%, reduces post-operative pain and eliminates any bleeding. Can I prevent this from happening again? Keep your feet clean and dry. Inspect feet frequently for new warts and begin treating small ones immediately, before they increase in size or number.