Plantar Warts

Plantar Wart | Verruca Pedis | Viral Skin Infection

What causes Plantar Warts?

Plantar warts are thick skin lesions caused by various strains of the Human Papilloma Virus (HPV). Wart at the bottom of the foot can be barely noticeable to uncomfortable and sore. The pain is sometimes enough to cause abnormal gait changes, to limit work and home activities up to be the source of some noticeable limping.  HPV is spread by direct skin-to-skin contact or autoinoculation. This means if you scratch or pick your wart, the viral particles may likely spread to another area of your body. This also means that if you walk barefoot on a floor into a public area, you either run the risk to get infected or to transmit your infection! The incubation period (lag time) of the HPV skin infection can be as long as twelve months. It means that your plantar wart may only appear up to twelve months after you got infected by the viruses.

What is the best practice in assessing plantar warts?

 Traditionally, wart diagnosis was made from a direct naked eye examination. But today, Doctors of Podiatric Medicine at Ottawa Foot Clinic are more and more confronted with features that overlap with other pedal skin lesions, preventing an accurate diagnosis to be made with certainty as easy as it used to.

This why your Doctors of Podiatric Medicine will often perform a more comprehensive skin examination using a polarized light, hand held, classic or digital microscope known as dermatoscope.

This classic non-digital dermatoscope offers a 10 X magnification under polarized illumination with a 1/10 mm ruler.

Digital dermatoscopes fixed to iPhones allow better documentation and instant communication with patients and physicians

Dermatoscopes are modified magnifying lens equipped with a ruler. The magnifier device can nowadays be fixed to an iPhone. It allows the foot specialist to:

  • accurately distinguish wart from corn, callus, trauma, cancer or foreign body skin lesion;
  • dispense a far more predictable wart treatment because no wart lesions – otherwise invisible under naked eyes – will be left untreated.

Why is it best practice to revaluate progress under magnification?

Examining skin under magnification at late stages of wart treatment avoid therapy not to be stopped prematurely due to unidentified tiny leftover wart structures only visible under magnification.

Dermatoscopic skin exam will assist seasoned foot specialists at Ottawa Foot Clinic in 5 ways because magnification helps to:

  • measure and monitor any type of skin lesions – albeit warts, calluses, foreign body or cancer lesions;
  • store the clinical pictures to be sent to colleagues whenever referral/consultation is necessary;
  • show you the progress being made since your first visit;
  • precisely assist the decision to continue or stop wart treatment;
  • confirm the indication to continue with same approach or switch to another option if unresponsive.

How does a plantar wart look like under magnification?

Dermatoscopy of a typical verruca plantaris reveals regularly distributed, tiny, red, brown to black dots with linear red to brown streaks of hemorrhages on a light yellowish to brownish background. The pigmented dots are the tips of small thrombosed capillary blood vessels that protrude toward the surface of the infected scaly skin.

These capillaries are in excess number to nourish the increased skin turnover due to the presence of viruses into the nucleus of the infected skin cells. These dotted or pinpoint vessels can help in selected cases to distinguish calluses from warts. Dermatoscopic skin exam of a callus typically reveals a structureless pigmentation pattern with no dots.

What are the risks to let my plantar warts untreated?

  1.  Since you are contagious, you will most likely transmit your viral skin infection to many people down the road. Think how many times a week you are barefoot in private or in public areas such as gyms, showers, pools? Also, think about bedtime where you are most likely to get in direct physical contact with the feet of your loved one.
  2.  You are also contagious for yourself. Over time, your wart lesion will get bigger and more difficult to treat. Over time, your mother lesion will spread so you may end up with a dozen of them!
  3. One has to remember that persistent plantar warts may rarely be complicated by the development of verrucous carcinoma – a wart-like type of skin cell cancer. Skin patterns such as hyperpigmentation on the ridges are highly specific, much easier to assess under magnification and should always raise suspicion. Then a referral for a second opinion – before instituting any wart treatment – is the best option.

Will my plantar wart ever subsides by itself?

Most likely not! These days, viruses are getting more and more resistant to our immune system, to most over-the-counter wart preparations and to most classic wart treatments such as uncomfortable nitrogen oxide, salicylic acid or cantharidine applications. We meet with patients who tried with those classic options for over 52 weeks in a row. With no results. And oftentimes getting worse!

The more you wait to get helped from a seasoned foot specialist, the stronger your viral skin infection will get, the more treatment sessions you will need.


What is – our hands and in our opinion – the most predictable plantar wart treatment option for adults?

Bleomycin injection* into the wart lesion is by far the most predictable option. Approximatively 90%** of our patients will be completely healed one month after their initial visit. 9%** will need a second injection as 1%** will not respond unless surgical excision is performed. Most patients get wart-free within one month or two!

*Bleomycine plantar wart injections can only be performed by a registered podiatrist in Quebec – as this treatment is part of the Doctorate of Podiatric Medicine 4-year training program offered at the Université du Québec à Trois-Rivières. This is why your wart treatments will be scheduled at the Clinique Podiatrique de Gatineau of your choice in Hull or Aylmer.

** All percentage are only rough estimates. These are not derived from clinical studies but only from our clinical experience. We do not keep any specific record to support the aforementioned percentages.


A sore wart lesion at the inside of the heel of the right foot appeared 12 to 14 months ago. As the increase in skin thickness and volume was compressed in her shoes, it created friction and more and more pain. Especially whenever playing volleyball and badminton. From time to time she would stop playing.

After only one treatment using bleomycin intralesional needless injection, the original lesion – 2 cm (20 mm) in diameter – was reduced to two tiny 3,5 mm spots. The patient was already 100% back in her games. This good response to initial treatment clearly set the indication to perform a second treatment using same approach.

A needleless injection instrument was used to project – at the speed of the sound – the bleomycin medication deep inside the wart lesion. This is the second treatment performed 4 weeks after the first treatment.


The Dermo-Jet injecting device is activated so the bleomycin medication is injected where needed. The area of treatment is covered with a skin colored bandage for 24 to 48 hours.

What is – our hands and in our opinion - the second most predictable plantar wart treatment option for adults and children?

In toddlers and teens with much thinner foot skin and with mild to moderate wart lesions, we tend to begin with a series of three consecutive gentle laser treatments followed by cantharidine applications performed every three weeks. Most patients get wart-free within two to three months.

This young active boy showed up with non-visible plantar wart lesions at the bottom of his left forefoot. Lesions had been identified and precisely localized under 10 X magnification.
We then use a sterile scalpel to gently remove the top layer of the infected and hypertrophied skin. This first step uncovered three minute wart lesions measuring 1, 2.5 and 4 mm in diameter.
All three lesions had been gently frozen using a nitrogen oxide cryotherapy device immediately followed by laser microsurgery to volatilize the infected skin cells. Cantharidine was applied and lesions were covered for 48 hours.
Here, we are about to perform the second laser treatment on a 1 mm residual wart lesion at the plantar aspect of the big toe of the left foot.
The laser is now activated.
Three types of plantar skin lesions were identified under magnification before instituting treatment: 1. Uncomfortable plantar wart 2. Discrete and exquisitely painful Focal Hyperkeratotic plantar lesion named Porokeratosis Plantaris Discreta (PPD). This is a hard keratin plug that feels like walking on a pine needle inducing abnormal gait changes 3. Asymptomatic hyperpigmentation of the skin as the first manifestation of either a second wart or PPD lesion.
All three lesions had been lasered out and covered with a thin skin-colored dressing. The patient was leaving the clinic happy to be able to walk normally and without pain!
22 days after the initial visit and laser treatment, the skin was debrided using a small blade to remove the superficial layer of dead skin revealing that all three lesions are now a thing of the past! This great result was double-checked under 10 x magnification. The patient never felt so good with her right foot!

Get Your Viral Wart Infection Laser Out Of Your Foot!

You need to get rid of these skin over growths that make it more and more difficult to walk. Since your wart or skin viral infection is contagious, it may spread out to your other foot or you may even be transferred to someone else’s feet. So it is important to get rid of this viral infection before you get more of them and before you passed it on … to family, friends and community members in contact with the grounds you share with them. Home remedies and over-the-counter preparations such as salicylic acid and repetitive liquid nitrogen applications are less and less successful since the viruses causing the wart are becoming more and more powerful and resistant over time. That explains why plantar warts do rarely subside by itself. That also explains why warts remain now unresponsive to old treatment options that were once effective. Options developed 10, 20 or 30 years ago are becoming less and less effective! Why not let the foot specialists at Ottawa Foot Clinic diagnose your problem, identify which option is best for you and put it into action right away?

The best approach to get rid of the wart fast is the laser therapy. First, we freeze with liquid nitrogen, second we laser the effected area and third we put on a vesicant medicine covered with a tape to be kept into place for 24-48 hours. This wart tritherapy protocol is the most effective way to treat most wart lesions. The laser cauterize the tiny blood vessels which were nourishing and perpetuating the wart, cause the infected tissue to die and gradually slough off. The treatment is simple, virtually painless in most cases, and won’t damage surrounding skin. In severe cases, it is best to proceed with a  minor surgery.

Are you ready to get rid of your plantar wart, be able to walk without pain again and with the peace in mind that you cannot transmit the disease anymore? Call (613) 595-9700 to set up an appointment at Ottawa Foot Clinic in Ontario and put an end to those pesky growths—the modern, most effective way.

How We Identify Plantar Warts, Time after Time, with Certainty?

In many cases, warts are quite easy to identify. But, more and more frequently, plantar warts have atypical clinical presentations that they are very difficult – if not, impossible – to identify with accuracy only using our God-given eyes.

It means that your plantar wart may be misdiagnosed as a corn or as another type of skin lesion and that you may end up with the wrong treatment approach!  It also means that the treatment may be stopped prematurely as a tiny invisible wart lesion is still present. And boom, the wart will recur!

For sure, toward the end of the wart treatments – usually at the second or third appointment – we need to re-evaluate for sure the presence or the absence of the residual lesion in a very reliable way.

This why we use right from the start, a dermascope, a 10 X magnifier instrument, to properly identify any skin lesion we encounter and to precisely measure the wart diameter down to the 1/10 of mm, so we are empowered to closely monitor progress and reevaluate our approach.

Plantar Warts: Causes and Treatments