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Plantar Warts

Plantar warts (verrucae plantaris) are skin lesions caused by the human papillomavirus (HPV), commonly found on the soles of the feet.

They are highly contagious, often resistant to treatment, and prone to recurrence.

 

What are plantar warts?
Treatments
References

What are Plantar Warts?

Plantar warts are small, rough, skin growths that appear on the bottom of the foot, usually on areas that bear weight, like the heel or ball of the foot. They are caused by a virus called human papillomavirus (HPV).

You can think of them as a type of skin infection where the virus gets into the skin through tiny cuts or cracks, especially if your feet are exposed to shared surfaces like swimming pools, communal showers, or locker rooms.

What Causes Plantar Warts?

Plantar warts develop when HPV enters the skin, usually through small breaks or damage. This virus then infects the bottom layer of skin, causing the skin cells to grow faster than normal, leading to a thick, hard lump that becomes the wart.

What Do They Look and Feel Like?

They may look like a small, grainy bump or thickened patch of skin (often confused with a callus).

They often have tiny black dots in them — these are small blood vessels (capillaries) that have clotted.

They usually interrupt the natural lines of the skin on the foot.

They can feel like you're stepping on a pebble or stone and may be painful when standing or walking, especially when squeezed from the sides.

Treatments for Plantar Warts

It is important to understand that as every clinical presentation is different, the suitability of a treatment intervention and how someone may respond to a treatment intervention will differ. 

A cause for concern when seeking treatment, is when a clinic/clinician applies the exact same treatment approach or "protocol" to every person presenting with a condition.

First-line / Most Common Treatment Options

Salicylic acid

Keratolytic, induces inflammation.
Requires daily application for weeks/months.
Safe and accessible.

Cryotherapy (liquid nitrogen)

Destroys wart by freezing.
More painful and less effective than salicylic acid.
Not ideal for young children or at-home use.

Other treatments (for recalcitrant warts)

Immunotherapy (e.g. Mycobacterium w vaccine).

Cantharidin.

Intralesional bleomycin.

Laser ablation.

Surgical excision.

Duct tape occlusion (mixed evidence).

Imiquimod or 5-fluorouracil (limited evidence).

Note: No treatment shows universal effectiveness. Recalcitrant warts (>6 months) are harder to treat.
Many therapies fail to address the root cause: persistent HPV infection.

Prevention

Given HPV’s resilience and ability to evade immune responses, prevention is challenging, but includes:

Behavioural:
- Avoid barefoot walking in communal areas.
- Maintain personal hygiene.
- Don’t share shoes, socks, or equipment.
- Keep feet dry and clean.

Environmental:
- Sanitise surfaces and equipment.
- Dry shoes thoroughly between use.

Medical:
- Consider quadrivalent HPV vaccine in high-risk populations.
- Treat existing warts promptly.
- Cover warts to reduce spread.

What Causes Plantar Warts?

Plantar warts develop when HPV enters the skin, usually through small breaks or damage. This virus then infects the bottom layer of skin, causing the skin cells to grow faster than normal, leading to a thick, hard lump that becomes the wart.