Embarrassing foot problems: Verrucae

Do you suffer with verrucae? You're not alone. At Ayres Health we see them regularly and have come to know them well!

A verruca is basically a wart that occurs on the bottom (plantar) of the foot. Warts are small skin growths which occur due to the Human Papilloma Virus (HPV).

Cause

Direct contact with the HPV virus is needed for a verruca to develop. This virus is not highly contagious, and it's unclear why some people develop verruca’s and others don’t. Contact with infected skin cells is needed such as from the floors of changing rooms, shower cubicles or around swimming pools.

The virus enters the skin through tiny cracks in it's surface. Moistness and maceration of the skin or very dry, cracked skin make it easier for the virus to enter. The incubation period can be up to 12 months so the verruca may not appear immediately after contact with the virus.

Signs & symptoms

· Thickened skin (a verruca often resembles a corn due to its rough, protruding surface)

· Tiny black dots may be visible (dried blood in capillaries)

· A verruca may occur individually or in clusters

· In most cases there are no symptoms but there may be some discomfort if the verruca is on a weight bearing area of the foot.

Who gets verruca’s?

Verruca’s are common in children but can occur at any age. In people who are immune suppressed due to a medical condition, medication, stress or older age the verruca may not disappear despite treatment.

Can they be cured?

Unfortunately there is no guaranteed cure for verrucae. Treatments aim to encourage the immune system to recognise the virus and clear the verruca. A verruca will usually clear on its own within 2 years in children but can last longer in adults.

Tincture of time!

Verruca’s are rarely a serious problem, and many people choose not to treat them, as the treatment can be more uncomfortable than the verruca itself. If left to regress on their own, there will be no scarring. Up to 65% of viral warts will resolve on their own without treatment within 2 years of appearing. However, verruca’s can be painful, look ugly and cause embarrassment. In which case treatment may feel necessary.

Verruca debridement

The discomfort of a verruca is usually the result of thickened skin. Paring the verruca to reduce the hard skin can ease discomfort and help improve efficacy of treatments.

To pare a verruca at home, soak the foot in water for 5 minutes. File the thickened skin using a disposable nail file/emery board. Do this once or twice a week. If the skin has become very thick, a podiatrist can use a scalpel to debride the verruca.

Salicylic acid

Salicylic acid compounds work by removing surface skin cells.

Pare the verruca using the technique described above. Apply the paste directly to the wart and not the surrounding skin. Allow to dry and cover with a plaster or zinc oxide tape.

This treatment requires persistence and patience. The paste needs to be applied once daily for 12 weeks. If the skin becomes too sore, stop treatment until the discomfort has settled, then recommence. Salicylic acid treatment has been found to have a clearance rate of <50%, possibly due to people having to stop treatment due to soreness.

Freezing (cryotherapy)

Liquid nitrogen (a cold gas) is applied to the verruca, to destroy affected skin cells. The treatment often requires several appointments and is painful. A sore blister forms, followed by a scab which eventually falls off. Scarring and changes in pigmentation can occur. Evidence for this treatment is limited, and there is not enough research available to support its use over the use of simpler & cheaper salicylic acid pastes. Cryotherapy clearance rate is <50%. For this reason we do not offer cryotherapy at Ayres Health.

Verruca needling

This treatment involves puncturing the verruca with a fine needle under local anaesthetic. Due to the needle accessing the deeper dermis and subcutaneous layers, the body’s immune response in the treatment area is thought to be enhanced. Unlike cryotherapy, this procedure is unlikely to leave scarring and generally only requires 1 or 2 treatments. As with all verruca treatments, resolution is not 100% guaranteed and evidence is limited, however recent studies have found on average a 65% to 70% clearance rate. Here at Ayres Health we find that most verrucas resolve after the 1st treatment.

Prevention

A few tips to help you prevent and manage verrucae at home:

- Change socks and shoes daily

- Keep feet clean and dry

- Avoid bare feet in shared spaces

- Wear comfortable shoes with cushioned insoles to help reduce pressure

- Cover the verruca with a waterproof plaster before swimming

- Do not pick or scratch the verruca

- If treating at home, use a disposable file and do not use the same file on healthy skin

Lifestyle advice

If you have persistent verruca’s, it may be worth looking at your general health and lifestyle to see if there’s any changes you can make to help your immune system to function at its best.

Sleep

Adults need at least 7 hours sleep a night, teens 8 to 10 and children up to 14 hours! During sleep we produce cytokines which are proteins important for targeting infection as part of the immune response. Lack of sleep means fewer cytokines are released which may affect our immune function. Try to go to bed at the same time each night, avoid screens for at least an hour before bed and no caffeine after midday.

Diet

There’s some evidence that micronutrient deficiencies alter immune response in animals, and studies have found that zinc can help clear verruca’s in people who are deficient in zinc. Generally, eating a healthy, balanced diet with plenty of fruit, veg and fibre and avoiding processed foods will help improve well-being.

Exercise

Regular exercise can contribute to good general health and therefore to a healthy immune system. It may also contribute more directly by promoting circulation, allowing the cells of the immune system to move through the body more efficiently.

Stress

The mind and body are closely related, and many medical conditions can be exacerbated by stress. There is lots of ongoing research looking into the effect of stress on the immune system. Be kind to yourself and take time out for some you time. Don't feel guilty about doing this as a more relaxed you will benefit those around you too!

Verruca’s in children

Verrucas are common in children but due to their young and healthy immune systems they tend to clear much faster than in adults. If your child has a verruca that isn’t really bothering them, don’t worry about it. Try to stop them picking at the verruca to avoid spreading it around the foot, and cover with a waterproof plaster when swimming.

One treatment which has limited evidence but is safe to try in children is occlusion. Apply a non-breathable medical tape or dressing such as Duoderm to the verruca. Leave it on for a week or until it falls off, then soak the foot for 5 minutes and file the verruca. Dry the foot thoroughly and replace the dressing. Try this for about 4 weeks and no more than 2 months. By trapping moisture, a more acidic environment is created around the verruca, and any hard skin will be softened, making it easier to pare down.

Verrucas usually clear up within a few months in children and rarely last longer than 2 years. Most verruca treatments are painful with low success rates so verruca treatments for children should be very much a last resort.