Dermatology   [back to the Category]

Plantar Warts   [read the french version]

Author :   Dr Michel Canesi

Verrucae or human papillomata are benign tumours linked to a localised proliferation of the epidermis. Extensive research using an electron microscope has proved suspicions that their contagiousness is due to their viral origin. Nowadays, more than a dozen viruses of human papillomata (HPV) can be identified. Plantar warts are of type 1-HPVI and HPV2. This contagious viral infection (changing rooms, showers) is especially common amongst dancers.

There are three clinical pictures: a unique plantar wart, multiple, or mosaic plantar warts. Differentiation is based on the number of verrucae.

Common or unique plantar wart, also known as myrmecia.(Fig.5)


This is the most common type of verruca and is caused by HPVI. It is an endophytic verruca that is deep and painful. It can be clearly visible, rounded or oval in shape, greyish yellow, smooth or rough and is very painful to the touch. It is accompanied by a sharp and "exquisite" pain when laterally squeezed between two fingers. The stratum corneum forms a hard ring that encircles it. This type of verruca is, usually, covered by hyperkeratosis which generally lifts up, strongly resembling a plantar corn, the main differential diagnosis.


Multiple plantar warts


These are caused by HPV2. They can be profuse, spread over one or both feet, seated on the balancing points as well as the actual arch of the foot, set into the corium. They are more readily found amongst teenagers. They are often combined with palmar warts. Reoccurrence is very common. (Fig.2, Fig.3)




Mosaic plantar warts


These are superficial exophytic verrucae which are caused by HPV2 and are not so common. It is the juxtapositional or coalescent formation of between 5 and 10, or even more, verrucae. The hyperkeratosis which separates them goes over the top of some of them and is level with others. Therefore, the whole thing creates "a store of hyperkeratosis and verrucae" which can either be slightly painful or, it can make ballet dancing very difficult (Fig.1, Fig.4)


Treatment:

The diagnosis of plantar warts is based on good clinical knowledge as well as experience, especially in differentiation from plantar corns.

Written opinion amongst specialists varies, some recommend the abstention from treatment due to the spontaneous regression of the verrucae, whilst others maintain that their contagiousness, genuine virus storage banks, justifies treatment that is based on various measures:
Medical care:

- - keratolytics, salicylic collodion: this, in our opinion, is the best as it affects ballet dancing the least.


Surgical treatment:

- - surgical exeresis, which is not actually satisfactory. Cicatrization is long and painful with no guarantee of recovery. There is a high level of reoccurrence which takes place, moreover, on a scar that is hyperalgetic.


- Nevertheless, we can cite the various techniques used


Ablation or limited removal using galvanocauterization or electrocoagulation.

Use of a C02 laser.


Direct local radiotherapy is completely forbidden, because of the considerable risk of radiodermatitis and future degeneration.

Cryotherapy is the most frequently used method of treatment. It consists of 10 to 15 second applications of carbon dioxide snow or liquid nitrogen. However, several very painful applications are often required and these can be incapacitating for a dancer.