John R. Tkach, M.D.
300 North Willson, Suite 203B
Bozeman, MT 59715
(406) 587-5442

Plantar Warts

Patient Information Sheet

Plantar warts are warts on the bottom of the feet. The word "plantar" refers to the sole of the foot. It has nothing to do with farming. Warts on the bottom of the foot are harder to cure than warts in more common areas. Occasionally, they won't go away even after months of treatment at weekly intervals. There is a reason for this. Every time you step on your foot, the entire weight of you body pounds the wart deeper into your foot. The longer you wait to start treatment, the harder and more expensive it is to get rid of plantar warts.

Anything that drives the wart deeper into the skin will make the wart worse. Some of these factors are:

A wart is like an iceberg. What you see on top is just a small part of what's underneath.

Treatment

I will suggest we use the treatment that seems best based on my training and experience. I have treated thousands of warts. Instead of using one big treatment that hurts a lot, I like to use a series of small treatments each of which may hurt a little but is tolerable. First, I trim away the thick outer layer of dead skin down to where the wart starts to bleed. Don't worry. It's not your normal skin bleeding. The wart has its own abundant supply of blood vessels. The wart hides under the thick layer of dead skin. I know it does not seem to you as though there is a thick layer of dead skin on the bottom of your foot, but there is. Then I apply a small drop each of three acids. Each one kills the wart in a slightly different way. Phenol stings a little at first, but then it gets numb. Nitric acid burns a little and turns the skin brown. The brown color is temporary. Bichloroacetic acid is the second strongest acid used in medicine and the strongest I ever use. Usually it does not hurt a lot. After allowing the acids to work, I neutralize them with an alcohol pad. At this point, you can see a slightly yellow area in the middle of the wart. This yellow area is what's left of the wart.

Finally, I tape a pad of 40% salicylic acid over the wart. Your job is to keep it on all week. If it comes off, tape it back on at home. I use water resistant adhesive tape. When you take your showers at home, try to make them brief, quick, in and out. The night before you return for your visit, you may treat yourself to the luxury of removing the tape and plaster and taking a long shower or bath. When you peel off the tape, a big chunk of dead white skin will come off. That's okay. That's what we are trying to do.

The major complication of wart treatment is infection. If pus occurs, let me know so that I can phone in a prescription for an antibiotic to your drug store. It is okay to call me at home if it gets infected on the weekend. I won't charge you for a phone call for infection in your wart, so there is no reason not to call. If you cannot reach me, ask your family doctor to prescribe an antibiotic for you or go to the emergency room at the hospital. The risk of getting infection in the wart is small.

It is helpful to boost your cell-mediated immunity by taking Tagamet 400 mg twice a day. For children, the does is 100 mg twice a day.

There are two forms of plantar wart treatment that I discourage.

  1. Excisional surgery is cutting out the wart and putting in stitches. This often fails and it can leave a permanent painful scar.
  2. X-ray treatment. X-ray works but there is a small risk that it can produce skin cancer 15-30 years later. I do not feel the risk is worth it.

What You Can Do

  1. While the wart is being treated, wear shoes that are a little larger to relieve pressure on the wart.
  2. At swimming pools and in shower rooms, wear rubber flip-flops or aqua socks so your bare feet do not touch the ground. This should cut down on reinfection with warts.
  3. If your feet sweat a lot, consider using a drying powder like Zeasorb. If you want to try Zeasorb, ask me for a free sample. Sweat spreads the virus.
  4. Try to keep the Salacid plaster on all week.

You will have to read and sign a copy of this before being seen by Dr. Tkach for your plantar warts.

The information provided in these patient information sheets is offered for general informational and educational purposes only; it is not offered as and does not constitute medical advice. In no way are any of the materials presented meant to be a substitute for professional medical care or attention by a qualified practitioner, nor should they be construed as such.

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