What can you expect after plantar wart surgery. How long does the pain last after wart removal. What are the most effective methods for plantar wart removal. How to manage discomfort during plantar wart recovery. What are the risks of wart recurrence after treatment.

Understanding Plantar Wart Removal Procedures

Plantar warts, those stubborn growths on the soles of your feet, can be a persistent nuisance. When over-the-counter treatments fail, medical intervention becomes necessary. But what exactly does plantar wart removal entail?

There are several methods physicians employ to eradicate these viral growths. The choice of procedure depends on factors such as the size, location, and number of warts, as well as the patient’s preferences and lifestyle. Let’s explore the most common techniques:

Wart Excision: Surgical Removal

Wart excision is a straightforward surgical procedure that involves cutting out the wart and a small margin of surrounding tissue. This method is particularly effective for smaller warts or when there are only a few to remove.

• Performed under local anesthesia
• Can be done in a doctor’s office
• Requires careful post-operative care

Cryotherapy: Freezing the Wart

Cryotherapy uses extreme cold to destroy the wart tissue. While over-the-counter freezing treatments are available, medical-grade cryotherapy is much more potent and effective, especially for deeper plantar warts.

• Multiple treatments may be necessary
• Can be combined with topical treatments
• Minimal discomfort during and after the procedure

Post-Operative Care for Plantar Wart Removal

The success of plantar wart removal largely depends on proper post-operative care. Following your doctor’s instructions meticulously can significantly improve your recovery and reduce the risk of complications.

Dressing and Wound Care

After wart excision, your doctor will apply an antimicrobial ointment and a soft dressing to the surgical site. How should you maintain this dressing?

• Keep the initial dressing clean and dry for 24 hours
• Change the dressing daily using prescribed ointment or gel
• For cryotherapy, a simple band-aid may suffice

If blistering occurs after cryotherapy, should you pop the blister? While it’s generally advised to leave blisters intact, if discomfort persists, you can carefully drain it using a sterilized needle. Always leave the top of the blister in place as it acts as a natural protective barrier.

Weight-Bearing and Mobility

Depending on the location and extent of the wart removal, your ability to bear weight on the affected foot may vary. What can you expect in terms of mobility after the procedure?

• For wart excision, a surgical shoe may be provided
• Weight-bearing is typically allowed as tolerated
• Crutches may be necessary for warts removed from weight-bearing areas
• After cryotherapy, normal footwear can usually be worn comfortably

Managing Pain and Discomfort After Plantar Wart Removal

Pain management is a crucial aspect of recovery after plantar wart removal. The level of discomfort can vary depending on the removal method and the wart’s location. How can you effectively manage post-operative pain?

Pain Medication Options

For most patients, over-the-counter pain relievers are sufficient to manage post-operative discomfort. However, in some cases, stronger medication may be prescribed. What are the common pain management strategies?

• Tylenol or Advil for mild to moderate pain
• Prescription narcotics (e.g., Norco, Vicodin) for more severe pain
• Tramadol as an alternative for patients allergic to codeine

Are there any side effects to be aware of when taking prescription pain medications? Narcotic pain relievers can cause drowsiness, dizziness, and in some cases, nausea or constipation. If you experience severe itching, it may indicate an allergic reaction, and you should contact your doctor immediately.

Follow-Up Care and Monitoring

Regular follow-up appointments are essential to ensure proper healing and to address any concerns that may arise during recovery. What should you expect in terms of post-operative appointments?

• Initial follow-up within a week of the procedure
• Subsequent appointments as determined by your doctor
• Monitoring for signs of infection or recurrence

During these appointments, your doctor will assess the healing process, remove any sutures if applicable, and provide guidance on further care. It’s crucial to attend all scheduled follow-ups to optimize your recovery.

Understanding the Risk of Wart Recurrence

While plantar wart removal can be effective, it’s important to understand that recurrence is possible. Why do warts sometimes come back after treatment?

Plantar warts are caused by the human papillomavirus (HPV), which can remain dormant in surrounding tissue. This means that even after successful removal, there’s a chance the virus could reactivate and cause new warts to form.

Recurrence Rates and Prevention

What are the chances of a plantar wart returning after treatment? Studies suggest that recurrence rates can vary widely, but most relapses occur within the first year after treatment. To minimize the risk of recurrence, consider the following preventive measures:

• Keep feet clean and dry
• Avoid walking barefoot in public areas
• Boost your immune system through a healthy lifestyle
• Use protective footwear in communal showers and locker rooms

Comparing Wart Removal Techniques: Effectiveness and Recovery

With multiple options available for plantar wart removal, it’s natural to wonder which method is most effective. How do these techniques compare in terms of success rates and recovery time?

Excision vs. Cryotherapy

Surgical excision and cryotherapy are two of the most common medical interventions for plantar warts. Each has its advantages and considerations:

Which method is right for you? The decision should be made in consultation with your doctor, considering factors such as the wart’s characteristics, your medical history, and personal preferences.

Innovations in Plantar Wart Treatment

As medical research progresses, new approaches to treating plantar warts are emerging. What cutting-edge treatments might be available in the near future?

Immunotherapy for Wart Removal

One promising avenue is immunotherapy, which aims to stimulate the body’s immune system to fight off the HPV infection causing the wart. How does this approach differ from traditional removal methods?

• Utilizes the body’s natural defenses
• May provide longer-lasting results
• Potential for treating multiple warts simultaneously

Laser Therapy Advancements

Laser treatments for plantar warts have been refined in recent years. What advantages do these new laser techniques offer?

• Precise targeting of wart tissue
• Minimal damage to surrounding healthy skin
• Potentially faster healing times

While these innovative treatments show promise, it’s important to note that they may not be widely available or suitable for all cases. Always consult with a qualified podiatrist or dermatologist to determine the best course of action for your specific situation.

Living with Plantar Warts: When to Seek Treatment

Not all plantar warts require immediate medical intervention. Some may resolve on their own over time. However, certain symptoms or circumstances warrant professional attention. When should you consult a doctor about your plantar wart?

• Pain or discomfort that interferes with daily activities
• Rapid growth or multiplication of warts
• Changes in appearance or bleeding
• Failure of over-the-counter treatments
• Compromised immune system

If you’re unsure whether your plantar wart requires treatment, it’s best to err on the side of caution and seek a professional opinion. Early intervention can prevent the wart from spreading and reduce the likelihood of complications.

Self-Care for Plantar Warts

While awaiting treatment or for minor cases, there are several self-care measures you can take to manage plantar warts at home. What are some effective home remedies for plantar warts?

• Salicylic acid treatments (available over-the-counter)
• Duct tape occlusion therapy
• Regular pumice stone exfoliation
• Maintaining good foot hygiene

Remember that these self-care methods may take weeks or even months to show results, and they may not be effective for all cases. If you don’t see improvement after several weeks of consistent treatment, it’s time to consult a healthcare professional.

The Psychological Impact of Plantar Warts

While plantar warts are primarily a physical concern, they can also have significant psychological effects on those who suffer from them. How do plantar warts impact a person’s mental well-being?

Social and Emotional Consequences

Living with plantar warts can lead to various social and emotional challenges. What are some common psychological effects experienced by individuals with plantar warts?

• Embarrassment or self-consciousness about foot appearance
• Anxiety about spreading the warts to others
• Frustration with persistent or recurring warts
• Depression related to chronic pain or limited mobility

It’s important to address these psychological aspects alongside the physical treatment of plantar warts. Open communication with your healthcare provider about these concerns can lead to a more comprehensive and satisfying treatment experience.

Coping Strategies

Dealing with the psychological impact of plantar warts requires a multifaceted approach. What strategies can help individuals cope with the emotional aspects of living with plantar warts?

• Educating yourself about the condition to alleviate fears
• Joining support groups or online communities
• Practicing stress-reduction techniques
• Focusing on overall foot health and self-care

By addressing both the physical and emotional aspects of plantar warts, individuals can maintain a positive outlook and actively participate in their treatment journey.

What To Expect After Wart Surgery

What to Expect After Wart Removal

You’ve talked to your doctor about getting rid of your warts. You’ve tried different over-the-counter or home remedies. You realize they will not go away with anything that you have tried and now it is our turn! Your biggest question is what does it take to get rid of a wart?

There are several different ways to get rid of a wart.  You may have already discussed the options for wart removal and which options are best suited to your life style. Your doctor may try a combination of several approaches based on your input.  I will go through these options again to help clarify your choices

Wart Excision

This procedure literally involves cutting out the wart. This is done under local anesthesia and can be performed at the office.  This usually works best on small warts in size or in number since a rim or margin around the wart must be excised as well to help reduce the risk of the wart spreading.

• Dressing: A topical antimicrobial ointment or gel followed by a soft, dressing is placed on your foot. You should keep this clean and dry until the next day, then you may change the dressing daily using only the ointment or gel prescribed by your doctor.
• Weight-bearing: You may be placed in a flat surgical shoe, depending on your particular surgery. You may bear weight to your comfort level.  Some patients may have more discomfort depending on the location of the wart.  Should you have a wart removed in a prominent weight bearing area such as the heel or the ball of the foot, you may need the use of crutches.
• Pain management: Usually, Tylenol or Advil is plenty to allevate the discomfort associated with this prodecure.  Narcotic pain medication may be dispensed, however, depending on the size of the wart. This is usually a codeine based narcotic like Norco or Vicodin. For those patients that are allergic to codeine, Tramadol is commonly used. All narcotics will make you a little sleepy and goofy, or in some cases, actually wired. They may also upset your stomach and make you constipated. Your surgeon may have to prescribe you an anti-nausea medication like Phenergan or Zofran. If you are itching all over, you are having a codeine reaction and should call your doctor.
• Post-operative appointments: Every doctor has their own protocols when it comes to post-operative follow up visits. You should talk to your doctor about their specific protocols.  You will most certainly have an appointment scheduled for follow up.
• Realistic Expectations: A wart is a virus, and like any virus, it is not easy to get rid of. Most recurrences will happen within a year of resolution. 

Cryotherapy

You may have heard and even tried the over-the-counter freeze sprays to get rid of your wart.  This stuff may penetrate through the smaller superficial warts found on fingers or the top parts of your feet, hands or on the body.   The warts on the bottom of the feet run deeper because the skin in this area is thicker and develops callus.  Your doctor will use a much stronger freeze therapy (cryotherapy) on those resistant warts and several treatments will be required.  Some times additional topical treatment in the form of a mild acid or an anti-viral cream is needed depending on the appearance of the wart.

• Dressing: A band aid is usually protective enough after cryotherapy. If it starts to drain or the area blisters, you should apply an over-the-counter topical antimicrobial ointment (preferably Bacitracin ointment).  If the blister is uncomfortable, soak a needle in rubbing alcohol for 15 minutes, then puncture the blister on the sides of the blister allowing the fluid to escape.  Leave the top of the blister intact.  It will act like Mother Nature’s band aid!
• Weight-bearing: You may wear a regular shoe or sandal to your comfort.
• Pain management: Cryotherapy does not produce any long lasting discomfort and pain medication should not be needed.   If there is any lingering discomfort, Tylenol, Motrin, or Advil should suffice.
• Post-operative appointments: Every doctor has their own protocols when it comes to follow up visits. You should talk to your doctor about their specific protocols.  You will most certainly have an appointment scheduled for follow up.
• Realistic Expectations: A wart is a virus, and like any virus, it is not easy to get rid of.  Most recurrences will happen within a year of resolution. 

We are constantly researching the literature for the latest in wart treatments.  If we find other options, we will certainly offer them to you as well!

Plantar warts are often hard to treat. They are stubborn.

Ask any practitioner, and most say that treating warts can be frustrating for both the practitioner and the patient. Why? This is because whatever treatment method is used, there is a chance of failures and recurrences.

I highly suggest patients with plantar warts read this post thoroughly, but if you don’t have time or interest, at least read the available treatments at the end of this article. This is crucial for patients to understand the different types of therapy, adverse effects, expected outcome (prognosis) and cost.

In chiropody/podiatry settings, we see patients with plantar warts daily. But not all warts are easy to treat, especially if the wart has been there for more than two years. Warts are usually harmless and can disappear without treatment within the first few months. But they can also cause discomfort, pain, and cosmetic concerns. After all, this wart is an infection and needs to be treated.

Plantar wart (verruca pedis) is a skin infection caused by Human Papillomavirus (HPV) and passes between people through direct contact with the viral particles (skin-to-skin contact), but can also be transmitted by indirect contact such as walking barefoot on contaminated surfaces (public areas including locker rooms, shower, gym, etc.), socks, shoes, towels and sports equipment. Some activities, such as picking at warts with fingernails or objects such as nail clippers or pumice stones, can also result in the transference of infection to hands or other parts of the body. Patients should be encouraged to wear proper foot coverings like shower
shoes or sandals when walking on possibly contaminated surfaces in public areas
to avoid any direct skin contact. Any item that comes into contact with a wart
should be thoroughly washed with hot water and soap. If you have a plantar wart, it is a good idea to cover it with tape or “verruca socks” and poolside sandals if you go to public areas such as a swimming pool. Moreover, simple domestic hygiene, such as cleaning the baths or showers after use and avoiding shared towels or socks, is essential to reduce the risk of cross-contamination. If the wart is under or around the nails, biting the nails must be avoided, or the virus can easily cause oral wart infection.

It has been reported that Human papillomavirus can survive months to years on surfaces. The incidence increases during the school years to peaks in adolescence and early adulthood. There are over 150 types of HPV viruses (distinguished based on their DNA), of which only a few can cause plantar warts (and some other ones can cause genital, oral or anal warts). Each of these viruses behaves differently to some degree, and they have different preferred sites of infection. For instance, HPV-1 replicates in more keratinized skin areas such as palms and soles, while HPV-16 prefers the genital region.

To have the plantar wart, there should be some degree of skin impairment, such as abrasion, cut or maceration (too much moisture), so the virus can enter the skin and reach the stem cells at the basal membrane of the skin. That explains why swimming pools and shower rooms are a hotspot for getting plantar warts as the skin becomes softer in contact with water, and just a tiny hole can be a portal of entry for the virus. In addition, as the skin cells shed, viral particles are released and can be transmitted to surfaces where the virus will remain until picked up by a new host or spread to adjacent sites. That is why covering the wart(s) with a band-aid (or duct tape) is a good idea to prevent its spread.

Warts prefer a moist environment. Since warts are more likely to survive on sweaty feet, part of the treatment plan should be drying out the skin (with topicals such as Foot Fresh or Drysol).

Warts at the bottom of the feet (plantar warts) are usually more refractory to the treatment than typical warts and often grow inward. Moreover, HPV can survive by evading the host’s immune surveillance. Hence, different therapies and modalities are available to fight the battle against these sneaky viruses. However, none of these treatments is a panacea (there is no guarantee in medical treatments anyway). Also, we should remember that the number of wart lesions does not affect the treatment outcome (prognosis).

I call these viruses sneaky because most people do not know how they got the virus, but the virus finds its way and resides inside the infected cells, sometimes for years. The viruses live as parasites and introduce their DNA into the normal skin cells to reproduce themselves and also be able to hide from the human immune system. That is why it is common that the wart can survive more than 6 months because it knows how to protect itself from the immune system. That explains the challenge in treating warts and why immune-compromised people have massive and usually resistant warts.

There is a clinical impression that warts in adults, especially in elderlies, are slower to clear with or without treatment. There are reports that warts are more likely to disappear in children younger than 12 years old spontaneously.

Some literature also categorizes the wart lesion as a benign tumour because of the similar mechanism of an uncontrolled increase in cell growth and reproduction. That explains why some anti-cancer medications, such as Bleomycin and Fluorouracil (5FU), are used for wart viruses. Some types of warts, mainly genital warts, can transform into cancer, but this is extremely rare in the foot. However, if you see a wart similar to the image below, don’t wait; see your physician or chiropodist immediately.

               verrucous carcinoma

How long is the incubation time?

You may wonder how warts will show up long after the first contact. The answer is unclear, but we know it ranges from a few weeks to more than a year! (4 weeks to 20 months).

What does a wart look like? How can we distinguish it from corn?

Warts can manifest differently depending on the location, age, the subtype of the virus, the patient’s immune system etc. There are several clinical manifestations of the lesions, but we should remember that not every wart has all of the following criteria:

1. Black dots (present or not) (this one is diagnostic for warts)
2. Impaired skin lines (dermatoglyphics) in the lesion (checked better with dermoscopy)

1. Arrangement (single or confluent)
2. Level (Raised or flat)
3. Aspect (Rough/lobed or smooth/not lobed)
4. Border (usually sharply defined)
5. White skin flakes (present or not)
6. Colour (Yellow or red)
7. Overlying callus (present or not present)
8. Pain or no pain

The small black dots are widely accepted to be the end of thrombosed (clotted) capillaries (small vessels) within the lesion. If you see these black dots in a lesion, it is most likely a wart.

On the bottom of the foot, most plantar warts are beneath the pressure points, such as the ball of the foot, heels, and the tip of the toes (due to higher pressure and more possible damage to the skin). Individuals may have single or multiple lesions. Sometimes, a small cluster of warts that almost look like vesicles (small blisters) may form around a large wart, and sometimes multiple warts merge and form a larger plaque of warts called mosaic warts. These warts are sometimes the most difficult ones to treat.

What are the risk factors for Plantar Wart?

Major risk factors include having preexistent warts, being in close contact with someone with a preexistent wart, walking barefoot, hyperhidrosis (sweaty feet) and a compromised immune system.

Do all warts look similar?

There are different types of warts (based on their appearance), including common warts, plane warts, filiform or digitate warts, mosaic warts, periungual (around or under the nails) warts, Butchers’ warts (occupational handlers of meat, poultry or fish, mostly in the hands), and pigmented warts (mostly in Japanese people).

                                                                                        A cluster of plantar warts

Mosaic warts: These warts are plaques formed by the merging of closely grouped small warts and are one of the most stubborn ones caused by HPV type 2. Particularly in immunocompromised patients, mosaic warts can spread out and cover a large area on the bottom of the foot.

                                                                       Mosaic Wart – Note the small black dots in the wart.

Is there any immunity or vaccine for warts?

No, there is no immunity or vaccine for plantar warts. There are vaccines for other types of HPV infections (such as genitals) but not for plantar warts. We still do not fully understand why the immune system in a healthy person cannot get rid of plantar warts. But the main theory says that the virus hides itself and its DNA inside the skin cells (epidermal cells) and that is why the immune system cannot recognize it. However, reports are showing that humoral immunity may be established by antibodies that can prevent future reinfection of that specific HPV subtype.

Are warts painful?

It can be painless or painful depending on the location, the amount of callus, and the type of wart. Many patients with plantar warts present with pain or the sensation of a pebble or swelling under their feet. But generally, pain is not a diagnostic symptom for warts.

What are the available wart treatments?

Success in wart treatment depends on multiple factors; each patient will respond differently. Therefore, the treatment should be individualized based on age, pain tolerance, commitment to the treatment, financial status, location of the wart and the duration of the infection.

Different treatment options, including their expected outcome, adverse effects, degrees of pain, and cost, will be explained to the patient during the first appointment. Then based on the clinical manifestation and location of the wart, the patient’s age, expectations, pain tolerance, neural and vascular condition of the foot, and financial status, the practitioner will design a treatment plan.

Some practitioners prefer to monitor early warts in young children because these warts may spontaneously disappear within 2 years. However, not treating the wart can also allow the wart to persist longer and become more resistant. Usually, it is more difficult to treat a wart if it has been present for more than 6 months. Warts in adults are also more stubborn than in children.

Below, I listed several treatment options of which we can provide you with most of them at Orangeville Foot Clinic.

Occlusion:

No evidence-based research suggests covering warts cures them, and it is not suggested as the main treatment. However, covering the wart with adhesive or duct tape may be considered a complementary remedy.

Advantages: Covering the wart can reduce the risk of spreading. Low cost. No pain. Increases the efficacy of the main course of treatment.

Disadvantages: Skin reaction to the adhesive.

Salicylic Acid (and other types of acid treatments such as trichloroacetic acid):

It works by removing the keratin (outer layer of the skin) surface. Remember, warts hide in keratinocytes (cells full of keratin) and use them as a source of nutrition.

Advantages: Usually pain-free during and after treatment unless the skin reacts, leading to contact dermatitis or blistering. Low cost. Safe to use at home.

Disadvantages: Low success rate (39%). Takes weeks to months of daily applications, along with regular pairing (debridement) of the wart in the clinic. Not recommended for certain patients, including patients with diabetes, peripheral neuropathy, and poor circulation, as the acid can cause a wound. Prolonged treatment is not recommended in children and pregnancy. The lower success rate in children younger than 12y.

Before applying the acid, some suggest soaking in warm water for 5-10 minutes, then drying the area before using a file, emery board or pumice stone to remove the thickness of the lesion. Then apply the acid with occlusion by duct tape of a bandage.

Patient compliance is one of the most (and challenging) parts of this treatment regimen.

I usually suggest masking the normal skin around the wart with nail polish or cream-like polysporin before applying the acid compound.

Cryotherapy:

Freezing the wart off with liquid nitrogen is traditionally one of the most common routes of treatment in a doctor’s office. But it is not always the best choice of treatment. The overall success rate is less than 50%. Reports are saying it is less effective than Salicylic Acid. It has been said that freezing works by stimulating the immune system.

Advantages: Relatively low cost, 65% success rate on HPV type 1 (HPV-1).

Disadvantages: Painful during and after the treatment, the pain is unpredictable and variable between patients, needs several appointments in the clinic, more effective for warts on hand than feet, limited control over how deep the normal tissue under and around the wart will be damaged, requires regular wart paring (debridement), high rates of failure or recurrence, not recommended in patients with poor circulation, Raynaud’s or peripheral neuropathy. It can leave a scar and/or cause blisters. Because of the pain, this form of treatment is not recommended for young children.

Treatment is repeated every 2 to 3 weeks for up to 3 months. Double-freeze therapy is a technique in which the warts are frozen until a 1-2-mm ice halo forms, then fully thawed and immediately refrozen. This has been said to increase the efficacy of the treatment, but it can be very painful. This treatment should be avoided if the wart is on the nail matrix or superficial nerves such as the sides of the toes or over a bony prominence.

Liquid Nitrogen used for this technique should have a temperature of -196  ̊C. Over-the-counter products such as Verruca Freeze only freeze the tissue to -70  ̊C and are even less effective.

Canthacur (cantharides “κανθαρίδες” in Greek means beetle)

Hycleus lugens, is a coloured beetle that secretes cantharidin, and that is why this treatment is called “Beetle Juice.”

This is one of the most popular wart treatment options in our office.

Medications made from blistering beetles go back to ancient times. It has been used for wart treatment since 1950. Cantharidin (Canthacur) is a vesicant (blistering) topical that lyses the keratinocytes (outer layer of skin) where the wart viruses are residing.

The blister usually occurs 24-48 hours after application, but sometimes pain starts even earlier. It can cause a blood blister (dark blister) which is normal.

Several systematic reviews and research found topical cantharidin alone led to significant clearance of warts, especially when mixed with podophyllin and salicylic acid. This mixture is available as Canthacur Plus or Canthacur PS, which is stronger than regular cantharidin.

The application is painless, bloodless and rapid, making it suitable for pediatric use in the clinic. However, it can be quite painful during the next 2-4 days, especially in the weight-bearing areas. People experience different degrees of pain, and it can be due to different pain thresholds or body reactions to the medication.

The efficacy of the treatment can be increased by covering the wart with nonporous occlusion. Some use it for warts under the nails as it can spread under the nails and into the nail fold.

Advantages: Relatively low cost, success rate up to 80%, no pain during the application, low risk of scarring.

Disadvantages: Multiple appointments in the clinic every 1-4 weeks, not recommended for patients with diabetes, neuropathy and poor circulation, unpredictable pain severity after each treatment, blister.

FUN FACT: In its natural form, cantharidin is secreted by the male blister beetle and given to the female as a copulatory gift during mating. Afterwards, the female beetle covers her eggs with it as a defence against predators.

SWIFT Machine (microwave therapy)

Microwaves have been in clinical use for over 30 years, and it has been proven that they cannot cause any damage to the DNA of living things. The microwaves that are emitted from the SWIFT machine can generate heat in a limited and focused area on the skin.

The applicator tip of the device that contacts the skin is single-use to eliminate the risk of cross-contamination. Microwave treatment has some advantages over cryotherapy (freezing with liquid nitrogen). For example, the microwave travels in highly controlled and precise straight lines aligned with the device tip, so the heat spread or damage to the adjacent tissues is minimal. Both treatments are painful during the treatment, but unlike cryotherapy, there is usually no blistering or tenderness after SWIFT treatment. However, SWIFT treatment is more expensive. One advantage of this treatment compared to LASER is that SWIFT does not generate smoke or particulate debris, which can potentially be risky for the practitioner or the patient.

There is no pain after SWIFT treatment, and the patient can have normal activity after each treatment. The patient needs 1 treatment per month for 3-5 months, depending on the size and type of the lesions. During the treatment, we set the power of the microwave up to 10 watts, which gives us about 3mm penetration of the heat. Each treatment normally consists of 3 applications on each wart, lasting for only 2 seconds. We ask patients to stop using topically on warts at least 2 weeks before the treatment as it will significantly increase the pain during the treatment.

For more information, please visit the SWIFT company’s website by clicking HERE.

Needling (Falknor’s Technique):

The needling technique has been considered somewhat of a renaissance in chiropody/podiatry practice for wart treatment. It was first described by Dr. Falknor, an American practitioner, in 1969, and then many podiatrists and dermatologists followed and modified his technique. This method involves multiple needle penetrations right into the wart under local anesthesia.

The idea behind this treatment is to enhance immune response and also to introduce the virus into the deeper layers of the skin, where the immune system can detect the viruses. In many cases, if we attack the main and first wart (the mother wart), other warts may be cleared, even in remote areas.

In one study, a 69% success rate was reported, but other reports show a higher success rate.

It is advised to avoid NSAIDs (Advil, Aspirin, Naproxen, etc.) for about 48 hours. These painkillers are anti-inflammatory, and we do not want to reduce the inflammation after treatment as an inflammatory response is key to triggering the immune response to wart infection.

Advantages: Good success rate, can be done in one treatment session with 1 or 2 follow-up appointments (1 week and 3 months later). After 3 months, if the wart is still present, another needling treatment may be granted. Not much pain after the treatment.

Disadvantages: Numbing the area is painful, risk of infection or bleeding if the technique is not properly done,

LASER (low or high level):

Different types of LASER can be used for treating warts. Currently, our office is not equipped with a hot LASER.

Nd:YAG LASER has up to 96% cure rate. It basically burns the cells that contain the virus. Expensive.

Low-Heat LASER: repeatedly raises the temperature of the area to a tolerated level of about 50 °C.

CO2 LASER: Used on resistant warts. It can be painful after treatment, may leave scarring, may need multiple treatments, and smoke from the burn can be hazardous if proper ventilation is not provided.

Excision (surgery) = Curettage

This method is usually a last resort for stubborn warts. It is not suitable for warts that involve large areas of the skin.

Advantages: The fastest way to eliminate the wart is usually with a 65-94% success rate. Often only needs one treatment per site.

Disadvantages: Freezing the area, especially at the bottom of the foot, is painful. Also, there is still up to a 33% chance of recurrence. If the wart is at the bottom of the foot, surgery most likely ends up with scarring, which can be permanently painful on weight-bearing. Other adverse effects (like any other surgery) include post-operation pain, bleeding, infection, and recurrence.

Cauterization:

Similar to surgery or LASER, this method is to destroy the wart lesion. It can be painful during or after treatment; the smoke-generated afterburn can be hazardous for the practitioner or patient. You may need multiple appointments with or without numbing the area for larger lesions. Our office is not equipped with this treatment.

Bleomycin:

This is a chemotherapeutic agent that can be used for wart treatment. Not recommended for regular warts and is generally reserved for resistant warts that have failed multiple other treatments. This treatment is an intralesional injection of 0.1-1.0 cc of Bleomycin and may also need local anesthesia. One study showed complete resolution of recalcitrant plantar warts in 87% of the patients, with only 20% of the patients requiring a second injection. It can cause some damage to the healthy tissues around the wart, so precise injection is required.

Advantages: No evidence of systemic toxicity, high success rate, only one or two injections,

Disadvantages: Very painful during injection (so needs local anesthesia), risk of damage to the surrounding healthy tissues, may leave black eschar on the lesion that needs debridement 2-3 weeks after injection if it does not detach spontaneously, possible nail loss (temporary) or nail deformity (permanent) if injection has done close to a nail.

Note for practitioners: Bleomycin sulphate (0.25-1 mg/ml) is injected up to 3 times to a maximum total dose of 4mg in up to 2 injection sessions with a maximum total dose of 2000 units. Injection to the wart was confirmed by observing blanching in the lesion.

5-Fu (5-Flurouracil = Efudex cream) 

This is another chemotherapeutic agent that can be used for wart treatment. It works by inhibiting the cell growth of the infected skin cells. This treatment is also reserved for resistant warts.

Patients need to apply 5% cream/solution of 5-FU on the lesion twice a day and cover it with tape for a month. One study showed that a combination of 5% 5-FU and 10% salicylic acid had a 63% success rate compared with 23% when only salicylic acid was used.

It can also administer by intralesional injection of 40 mg/ml 5-FU weekly for up to 4 weeks (60% efficacy)

Advantages: Relatively inexpensive, few office visits for paring (debriding) warts, high success rate (some studies show up to 95%), generally painless

Disadvantages: Blistering, local irritation, and sometimes pain after each application. If used close to the nail, it can cause nail detachment (not recommended for warts under or around nails), can cause mild-moderate ulceration, and be contraindicated in pregnancy and breastfeeding.

Aldera = imiquimod (5% cream)

This medication is topical immunomodulation that is typically used for genital warts. However, skin warts such as plantar warts have also responded to imiquimod (Aldera) treatment. It stimulates cytokines (immune system).

The treatment should be done after debriding the wart. One protocol involves applying the cream on warts twice daily for up to 24 weeks. It can be combined with occlusion (duct tape) or salicylic acid. Another protocol suggests applying the cream 3 times per week for plantar warts.

Advantages: No pain, good success rate, well-tolerated in the compromised immune system, low recurrence rate, self-applied by adults, not many office visits required.

Disadvantages: Expensive, long treatment plan, possible local skin reaction leading to inflammation or pain.

Zinc and Vitamin A:

Zinc and vitamin A are known to have a mild effect on boosting the immune system. There is no solid evidence that taking zinc and/or vitamin A alone clears warts. Still, as there are no serious side effects to them, many practitioners suggest them as a complementary treatment.

It has been suggested that taking 15mg zinc tablet and 10,000 Unit Vitamin A 2 times per day for 30 days can increase skin turnover and complement the main course of treatment. You can buy these supplements from any pharmacy without a prescription.

If you would like to book an appointment, please call us at 519-942-4705, and if you have questions or want to send pictures of your warts, please contact us at [email protected]

Some of the references:

1- Plantar Warts: Epidemiology, Pathophysiology, and Clinical Management

2- The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases

3- What are the effects of heating the skin with microwaves?

How to care for a wart after laser removal

Warts are finally gone.

Only a small wound remained in their place.

She will heal soon.

Unfortunately, not all wart removal operations are successful. Sometimes there are scars. In other cases, inflammation begins. The consequences of removing a wart can be very unpleasant, so you need to take care of the proper healing of the wound.

We will discuss this issue later. For now, let’s briefly talk about the operation to remove warts, and in what cases it is performed.

People remove tumors for various reasons.

Some people don’t like the look and feel of warts.

Others are troubled by discomfort. Sometimes neoplasms grow in uncomfortable places – on the fingers or feet. Here they interfere with comfortable wearing shoes, and are often damaged and inflamed.

Of course, not everyone has such problems.

But there are still a lot of people who want to get rid of warts.

Usually there are no serious obstacles to the operation, and any person can easily remove even a lot of neoplasms.

Few contraindications:

• Pregnancy
• Herpes exacerbation
• Suspicion of melanoma
• Inflammation of the skin next to a wart
• Predisposition to scarring

Doctors use several methods to deal with neoplasms. Most popular:

• Laser therapy
• Cryodestruction
• Surgical removal
• Electrocoagulation

In principle, all methods are effective. But in recent years, patients often prefer laser surgery due to its high efficiency and lack of pain.

Regardless of the method of wart removal, negative consequences are possible.

Yes, they occur less frequently with laser therapy. However, the risk is still there.

It is important to take care of the wound from the removed wart all the time until it heals completely.

This period depends on several factors:

• Neoplasm size

Wounds smaller than a centimeter heal in two weeks. In larger areas, the skin recovers longer – up to a month.

• State of immunity

Strong immune system accelerates healing.

• Follow the doctor’s advice

Due to improper care, tissue repair can take several months, and sometimes the wound does not heal at all and a doctor’s help is needed.

As you can see, any patient can speed up rehabilitation after surgery. You just need to be patient and follow the doctor’s instructions – take care of the wound and use the right medicines.

Medicines for wounds from removed warts

In the early days, protect the wound from infection with antiseptic preparations. There are also substances that dry out the skin.

How to treat the wound after removing the wart?

It is recommended to lubricate the wound with Chlorhexidine at least 2-3 times a day, until a crust appears..

But alcohol solutions and various chemicals are strictly prohibited, as they damage the wound and slow down its healing.

Together with antiseptics, it is useful to use vitamins and tinctures to strengthen the immune system. With them, you will speed up the recovery of the skin and reduce the risk of new warts.

There are cases when the skin around the wound swells – this is normal and usually the swelling disappears in about a week. If it does not disappear, then consult a doctor.

The crust on the wound will fall off by itself. You can not scratch or pick it – this way you can deprive the wound of protection and infect the infection. After the crust disappears, use repair gels and ointments that will speed up the healing of lesions.

The wound should be treated regularly with suitable preparations, but it is important to follow the doctor’s other instructions.

Treatment regimen. Rules for care after wart removal

Many unpleasant consequences after wart removal are associated with improper wound care. Including long-term healing of the skin.

Here are a few simple rules that will help restore damaged skin in a short time:

1. Do not dry the wound with a towel. Strong friction can cause infection.

2. Do not take a bath

2 – 3 weeks only shower. Cover the wound with cosmetics, as they can slow down the recovery of the skin.

3. Do not swim in public waters and do not go to the solarium

Refrain from these procedures for two weeks – this way you guarantee normal wound healing.

4. Do not go to the bath and sauna

An unhealed wound is vulnerable to high temperatures, so wash only in the shower for 2-3 weeks.

One of the possible problems after surgery is the appearance of a scar or scar. Naturally, no one wants to change one unattractive external feature for another. Fortunately, this is easy to avoid.

First of all, do not cover the wound with a band-aid. Some people consider the patch to be a protection against bacteria, but at the same time, it prevents the inflow of air. Because of it, the wound heals longer.

Young skin at wart site needs sun protection. To restore the skin, it is important not only to treat the damaged area, but also to strengthen the immune system. A course of vitamins A, E, and C will accelerate skin regeneration and improve its elasticity.

After removing the wart, the wound festered. What to do?

See a doctor. He will examine the skin and determine why the infection began.

Also, a doctor’s help is needed when the wound heals for a long time – if it does not disappear even a month after the treatment.

When the operation is harmful. Consequences of laser wart removal

We have already mentioned the possible complications that are associated with the wound from the operation. There aren’t many of them.

The most dangerous consequences of laser wart removal:

• Long healing
• Infection and inflammation of the wound
• Scars and scars
• Burn
• Allergic reaction
• Incomplete removal of neoplasm

Individual complications are caused by the patients themselves. For example, infections and long healing. We talked about how to properly care for a wound after surgery, so let’s move on to other reasons for the dangerous consequences of laser wart removal.

A small percentage of patients suffer from allergies to anesthesia and a predisposition to scarring. This is a serious problem. Ask your doctor about other treatment options. So you can easily choose a method that will allow you to get rid of warts without complications.

There are also complications during laser surgery that depend only on the doctor – a severe tissue burn due to incorrect equipment settings and the reappearance of a neoplasm due to tissues not removed.

In the reviews of many patients, the severe consequences of laser wart removal are described.

Some even required additional treatment. That means extra expenses.

The importance of the qualifications of the doctor who performs the procedure cannot be underestimated.

Therefore, we suggest contacting the Lasersvit clinic.

Our medical center is not a cheap beauty salon. We employ dermatologists of the highest category with more than 17 years of experience who have examined over 100,000 patients. They are well versed in neoplasms and know well how to remove them. Without pain and scars. Our doctors will explain in detail how to properly care for wounds after surgery at home.

Here are the testimonials from Lazersvit patients:

• Svetlana

I was worried about a wart on my finger for a long time. Looks terrible. Always catches the eye and decided to remove it. I was advised laser removal, and I immediately rushed to read reviews about the operation. And there are a lot of positive reviews. As a result, I decided on treatment. It has now been 4 months since the operation, and in general I am satisfied with the result. Doctors from the Lasersvit clinic not only removed the wart painlessly, but also told in detail how to take care of it.

• Hope

Good afternoon. I want to briefly talk about how I removed a wart on my leg. The operation itself was quick and painless. True, the wound did not heal as quickly as we would like – in a month. But acquaintances told about other cases when the wound lasted much longer. So I have nothing to complain about.

• Zhenya

Decided to remove three neoplasms on the left leg. I was a little worried, but the doctors said that the operation was safe and painless. The warts were removed quickly, and the wounds healed in just three weeks. Walking was uncomfortable at first, but this is due to the location of the neoplasms. Then it got easier. Now, a month later, there are no unpleasant sensations when walking.

• Nicholas

Good afternoon. I want to tell you how I removed a wart on my arm. The procedure itself is very fast – only five minutes and the neoplasm disappeared. I had to deal with the wound longer – a whole month. But I did everything as the doctors advised, and as a result, young skin grew, and there were almost no traces of the operation. Therefore, I am glad that I applied to LaserSweet.

• Natalia

I read a lot of positive reviews about laser wart removal. As a result, she herself decided on the operation, when an unsightly neoplasm popped up on her index finger. Fortunately, not only the procedure was successful, but the wound healed pretty quickly. Small traces of the treatment still remain, but this is much better than with a wart.

• Oleg

At first I did not pay attention to the wart on my foot, but then it started to hurt a lot when walking, and I still went to the doctor at the LaserSweet clinic. He advised to remove the neoplasm. I signed up for surgery. I was given an anesthetic and the wart was quickly removed. It was not difficult to take care of the wound, and after a month it disappeared. So I’m happy with the treatment.

Come to LaserSweet and get rid of annoying warts without scarring, inflammation or other dangerous consequences.

Cryodestruction

In our clinic, a dermatologist performs cryodestruction (removal with liquid nitrogen) of benign neoplasms painlessly.

How is the wart removal procedure performed? Cryodestruction with liquid nitrogen is performed using an applicator, by means of deep freezing, the effect is made directly on the wart with a slight pressure for 10-40 seconds. During freezing, the formation begins to turn pale, thicken, turn white, after the procedure, the freezing site turns red and swells, after a few hours or the next day, a bubble with hemorrhagic or serous contents forms at this site. This vesicle dissolves on its own within 6-8 days and a crust appears in its place. After 10-14 days, the crust separates on its own and a pink spot forms in its place. After a week, the treated skin first darkens, then flakes off and the neoplasms disappear. Removal of plantar warts with liquid nitrogen The appearance of warts on the foot for a long time may not bother a person, but when they grow deep into the tissues, they cause pain while walking. Their favorite localization is on the fingertips, at the base of the fingers, on the heel, very often plantar neoplasms form in children. During the procedure for removing plantar warts with liquid nitrogen, there is always pain for the patient, since more pressure and more time are required for the freezing process. The recovery period is also more difficult, sometimes it leads to a person’s disability for 2-3 weeks, since it becomes impossible to step on the painful area of ​​the foot. In addition, for plantar warts, nitrogen treatment should be carried out 3-4 times every 3-4 days, in rare severe cases, treatment can be delayed up to 6 months. For high-quality processing, the doctor should determine the depth of exposure as accurately as possible so that after removal no dents form on the sole, and healthy skin is not damaged. What is the care of the wound after removing the wart with nitrogen? After a bubble appears at the site of the session, it should be protected from getting wet, pierced and try not to touch it, as well as 2 times a day – in the morning and evening, treat with a strong solution of potassium permanganate, or salicylic alcohol 2%.