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Chapter 140: Plantar Warts

E.J. Mayeaux, Jr.; Jonathan C. Banta

PATIENT STORY

A 15-year-old boy presents with painful growths on his right heel for approximately 6 months (Figure 140-1). It is painful to walk on and he would like it treated. He was diagnosed with multiple large plantar warts called mosaic warts. The lesions were treated with gentle paring with a #15 blade scalpel and liquid nitrogen therapy over a number of sessions. He and his mother were instructed on how to use salicylic acid plasters on the remaining warts.

FIGURE 140-1

Plantar warts. Note small black dots in the warts that represent thrombosed vessels. Large plantar warts such as these are called mosaic warts. (Reproduced with permission from Richard P. Usatine, MD.)

A photo shows dry, brownish warts with white spots in the heel.
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INTRODUCTION

Plantar warts (verruca plantaris) are human papillomavirus (HPV) lesions that occur on the soles of the feet (Figures 140-1, 140-2, 140-3, 140-4, 140-5) and palms of the hands (Figure 140-6).

FIGURE 140-2

Close-up of plantar wart on the side of the heel. Note the disruption of skin lines and black dots. (Reproduced with permission from Richard P. Usatine, MD.)

A photo shows close-up view of plantar warts in the heel. The warts appears as dry, flat, whitish patches.
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FIGURE 140-3

Close-up of a plantar wart demonstrating disruption of normal skin lines. Corns and callus do not disrupt normal skin lines. The black dots are thrombosed vessels, which are frequently seen in plantar warts. (Reproduced with permission from Richard P. Usatine, MD.)

A photo shows a plantar wart in the heel. It appears as a flat, round, dry whitish patch with brown margins and blackish spots within.
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FIGURE 140-4

A mosaic wart is formed when several plantar warts become confluent. This patient is HIV positive and the thrombosed vessels are visible in some of this large wart. (Reproduced with permission from Richard P. Usatine, MD.)

A photo shows a large mosaic wart in the heel. It appears as pale yellow to white, crusted, dry region made up of smaller warts.
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FIGURE 140-5

Multiple plantar warts on the ball of the foot and toes. The thrombosed vessels within the warts appear as black dots. (Reproduced with permission from Richard P. Usatine, MD.)

A photo shows several plantar warts in the sole and toes.
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FIGURE 140-6

Multiple plantar warts on the palms of an HIV-positive man. (Reproduced with permission from Richard P. Usatine, MD.)

A photo shows several plantar warts in the palm, appearing as round, brownish, dry patches.
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SYNONYMS

Palmoplantar warts, myrmecia.

EPIDEMIOLOGY

  • Plantar warts affect mostly adolescents and young adults, affecting up to 10% of people in these age groups.1

  • Prevalence studies demonstrate a wide range of values, from 0.84% in the United States,2 to 3.3% to 4.7% in the United Kingdom,3 to 24% in 16- to 18-year-olds in Australia.4

ETIOLOGY ...

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