From the Guidelines
Plantar warts causing painful walking can be effectively treated with cryotherapy and salicylic acid (SA) combination therapy, which has shown a high clearance rate of 86%. This treatment approach is recommended based on the British Association of Dermatologists' guidelines for the management of cutaneous warts 2014 1. The guidelines suggest that cryotherapy and SA can be used together to improve treatment outcomes, with the application of SA 30% prior to pulsed-dye laser (PDL) therapy appearing to decrease the number of laser treatments needed.
Some key points to consider when treating plantar warts include:
- Using over-the-counter salicylic acid products like Compound W or Dr. Scholl's, applying daily for several weeks after soaking and filing the wart, and covering with a bandage between treatments
- Trying cryotherapy products like Compound W Freeze Off, following package instructions carefully
- Using donut-shaped pads (corn pads) around the wart to reduce pressure and alleviate pain while walking
- Considering professional cryotherapy with liquid nitrogen, stronger acids, laser therapy, or surgical removal if home treatments fail after 2-3 weeks or if the wart is particularly painful
It's also important to note that plantar warts are caused by human papillomavirus (HPV) entering through tiny breaks in the skin, and they often resolve on their own within 1-2 years 1. To prevent recurrence, it's recommended to keep feet clean and dry, wear flip-flops in public showers, avoid touching warts, and not share footwear with others.
In terms of specific treatment recommendations, the British Association of Dermatologists' guidelines suggest that cryotherapy and SA can be used together, with the application of SA 30% prior to PDL therapy appearing to decrease the number of laser treatments needed 1. Additionally, the guidelines recommend using a double freeze–thaw cycle, which appears to be more effective than gentler freezing, but may result in more pain and blistering and an increased risk of scarring.
Overall, the most effective treatment approach for plantar warts will depend on the individual case, and it's recommended to consult with a healthcare provider to determine the best course of treatment. Cryotherapy and SA combination therapy is a recommended treatment approach, with a high clearance rate and relatively low risk of side effects 1.
From the Research
Treatment Options for Warts on Feet
- Salicylic acid is a commonly used treatment for warts, including those on the feet, and has been shown to be effective in increasing the chance of clearance of warts 2.
- Cryotherapy is another treatment option for warts on the feet, but its effectiveness may vary depending on the individual and the specific treatment protocol 2, 3.
- A combination of salicylic acid and cryotherapy may be more effective than either treatment alone 4, 2.
- Imiquimod 5% cream, used in combination with a keratolytic lotion, has been shown to be effective in treating plantar warts in children and may be a viable alternative to cryotherapy 5.
- Cantharidin-podophylotoxin-salicylic acid (CPS) is a topical treatment that has been shown to be more effective than cryotherapy in the treatment of plantar warts 6.
Effectiveness of Treatment Options
- Salicylic acid has been shown to have a modest therapeutic effect, with a risk ratio of 1.56 for clearance of warts at all sites 2.
- Cryotherapy has been shown to have varying degrees of effectiveness, with some studies showing no significant difference in effectiveness compared to placebo or salicylic acid 2, 3.
- Imiquimod 5% cream has been shown to be effective in treating plantar warts in children, with 81.1% of children treated with imiquimod 5% and salicylic acid being free from their warts after 3 months 5.
- CPS has been shown to be more effective than cryotherapy in the treatment of plantar warts, with 14 out of 26 patients being completely cleared of their warts with CPS compared to 5 out of 12 patients with cryotherapy 6.
Considerations for Treatment
- The choice of treatment for warts on the feet should be based on the individual's specific needs and circumstances, including the size and location of the wart, as well as any underlying health conditions 4.
- Treatment should be aimed at relieving physical and psychological discomfort, as well as preventing the spread of infection 4.
- Patients should be informed of the potential risks and benefits of each treatment option, including the possibility of adverse effects such as pain, blistering, and scarring 2, 3.