Verruca: A Podiatrist’s Perspective

Here is everything you need to know about verrucae, as well as treating and preventing them.

What Is A Verruca? 

A verruca is a small hard growth on the foot caused by the Human Papilloma Virus (HPV) which is contagious. It can spread through skin contact and indirect contact e.g. floors in a swimming pool, shower or gym. The most common areas of growth are on the sole of the feet or toes and are also referred to as plantar warts.  

Verrucae typically form a layer of callus (hard skin) and can contain black dots, though these are not always present. They usually have a cauliflower appearance and can be identified through disruptions of the normal skin striations (lines). A corn has no disruption to these striations and is usually painful when pressed directly, in comparison to verrucae, which are more painful when squeezed. These are good signs to differentiate between the two. 

A verruca can often go unnoticed for long periods of time as people tend to forget about their feet. They are more likely to seek treatment if the verruca begins to cause pain or discomfort. 

What Are The Symptoms?

• Small hard, raised lump on the foot 

• Often contain black dots (dried blood) 

• May have a cauliflower appearance 

• Pain (sometimes)

• Bleeding (maybe)

• May start as one small verruca and spread to the surrounding area creating a cluster (this is referred to as mosaic verrucae)

Best Ways To Prevent A Verruca

• Don’t share towels, hosiery or footwear

• When swimming, some parents prefer the use of verruca socks. These try to stop spread as there is a barrier between the skin and surfaces. However, the general thoughts on verruca socks show they may cause a psychosocial issue, where a child can feel embarrassed, or even bullied as they are singled out as being different  

• Wear flip-flops in communal shower rooms

• Don’t scratch verrucae or pick them 

• Wash socks/hosiery and towels at a high temperature. Above 60 degrees Celsius is recommended. Another option is to carefully soak the socks in a basin of boiling water and wash as normal in the washing machine after

How To Treat A Verruca

Time: Many verruca can spontaneously resolve without treatment. This usually occurs within 6 months for children, but up to 2 years for adults. The immune system recognises the virus, but it can take a long period of time for it to fight the virus naturally. Some parents choose the “occlusion method” where a tape covers the verruca for prolonged periods. Duct tape was used in the past, but zinc oxide or tiger tape are more skin friendly options. 

How You Can Treat A Verruca At Home

If you are fit, healthy and have no medical issues, you can ask your podiatrist or pharmacist for advice and recommendations for the best over the counter (OTC) treatment. Some examples include: wart paint, gel or a liquid nitrogen OTC pen. It is important to read the leaflet containing the instructions and apply as directed for the required timeframe. It is important to be consistent as sporadic treatment will have little effect.

Some OTCs advise filing the top layer of the skin with a nail file to allow the treatment to work more effectively. It is important to be careful doing so as the nail file make cause a break in the surrounding skin and cause the verruca to spread. Over the counter treatment is thought to be quite effective for children. However, it is difficult to determine if the treatment application or simply time resolve the verruca.  

If you are pregnant or breastfeeding, it is advised not to have any treatment as no studies have been performed on these groups to check for side effects. Treatment can be commenced after birth, or when breastfeeding has completely ceased. It is important to note, the mother’s immune system changes during pregnancy and the verruca may resolve once the immune system returns to normal. If you have poor circulation, diabetes, or any other conditions affecting foot health you should not self treat and should see a podiatrist for an assessment.  

What To Expect During A Podiatry Appointment For Verrucae

• The podiatrist will take a detailed history. They will ask questions such as, when did you first notice it? Have you tried any over the counter treatments? Have you seen another healthcare professional such as a GP for treatment? Does anyone else you are living with have a verruca?  

• They will explain the treatment options, the procedure and ensure you give consent to proceed.  

• They will check the pulses in your feet and make sure it is safe to use a scalpel.  

• They will then debride/remove the top layer of the verruca using a scalpel blade. As a verruca is highly vascular, it is likely to bleed. 

• They will protect the healthy tissue, apply the treatment and dress then area.  

• They will tell you to keep the dressing on for a period of time, keep the dressing dry and clean. 

• They may provide advice for self treatment between podiatry appointments, which are usually 1-2 weeks apart. 

• Cryotherapy is another treatment your podiatrist will consider; this is where verruca is frozen with liquid nitrogen. This is available in selected clinics at Spectrum Health and you can contact us for further details of availability.

Tips For Children  

We know it may be scary for children to come into a clinic and have the painful part of their foot treated. We can lay the treatment bed flat so they can’t see the sharp instruments. It is recommended to bring in their favourite teddy, their favourite treat or a phone/iPad to distract them. The longer they stay still, the quicker the skin will be removed and the treatment applied. If the child is moving, it is unsafe to remove the dead skin with a sharp scalpel blade, so you may need to come back another day.  

How Quickly Will The Treatment Work?

As it is a virus, it is difficult to estimate the number of podiatry treatments required.  This largely depends on the number of verruca and the length of time present. Our podiatrists can talk through and discuss the most effective treatment for you.