From the Guidelines
A hemorrhagic plantar wart near the metatarsophalangeal (MTP) joint is characterized by a well-circumscribed, hyperkeratotic lesion with visible black or dark red dots representing thrombosed capillaries, typically appearing as a rough-textured, firm papule or plaque with a defined border that interrupts normal skin lines. The lesion is usually painful upon lateral compression or when bearing weight, causing the patient to alter their gait 1. The wart may show a central depression surrounded by a thickened collar of hyperkeratosis, and the patient may report tenderness when walking or standing. This appearance distinguishes plantar warts from calluses, as warts will disrupt dermatoglyphics (skin lines) while calluses preserve them. Key characteristics of a hemorrhagic plantar wart include:
- A rough-textured, firm papule or plaque with a defined border
- Visible black or dark red dots representing thrombosed capillaries
- Disruption of normal skin lines (dermatoglyphics)
- Pain upon lateral compression or weight-bearing
- Possible central depression surrounded by a thickened collar of hyperkeratosis The hemorrhagic appearance results from the human papillomavirus (HPV) infection stimulating excessive blood vessel growth, which then bleeds into the wart tissue when traumatized during normal walking activities, as noted in the British Association of Dermatologists' guidelines for the management of cutaneous warts 1.
From the Research
Description of a Hemorrhagic Plantar Wart near MTP
To describe a hemorrhagic plantar wart near the metatarsophalangeal (MTP) joint, consider the following characteristics:
- Location: Plantar warts are typically found on the sole of the foot, often near the heel or ball of the foot, and can also occur near the MTP joint 2.
- Appearance: A hemorrhagic plantar wart may appear as a small, rough growth on the skin, with a characteristic cauliflower-like appearance, and may have a black dot in the center, which is a thrombosed capillary 3.
- Symptoms: Plantar warts can be painful, especially when pressure is applied, and may cause discomfort when walking or standing 4.
- Size: Plantar warts can vary in size, but are typically small, ranging from a few millimeters to several centimeters in diameter 5.
- Color: The color of a plantar wart can range from flesh-colored to brown or gray, and may have a yellowish or blackish tint due to the presence of thrombosed capillaries 6.
Treatment Options
Treatment options for plantar warts include:
- Topical treatments, such as salicylic acid, which can be effective in treating small warts 4, 3.
- Cryotherapy, which involves freezing the wart with liquid nitrogen, and can be effective in treating larger warts 4, 5.
- Other treatments, such as cantharidin-podophyllin-salicylic acid formulation, laser therapy, and intralesional bleomycin, which may be effective in treating resistant or recurrent warts 5.